Computer‐based simulation to reduce EHR‐related chemotherapy ordering errors

Abstract

Background The electronic health record (EHR) is a contributor to serious patient harm occurring within a sociotechnical system. Chemotherapy ordering is a high‐risk task due to the complex nature of ordering workflows and potential detrimental effects if wrong chemotherapeutic doses are administered. Many chemotherapy ordering errors cannot be mitigated through systems‐based changes due to the limited extent to which individual institutions are able to customize proprietary EHR software. We hypothesized that simulation‐based training could improve providers’ ability to identify and mitigate common chemotherapy ordering errors. Methods Pediatric hematology/oncology providers voluntarily participated in simulations using an EHR testing (“Playground”) environment. The number of safety risks identified and mitigated by each provider at baseline was recorded. Risks were reviewed one‐on‐one after initial simulations and at a group “lunch‐and‐learn” session. At three‐month follow‐up, repeat simulations assessed for improvements in error identification and mitigation, and providers were surveyed about prevention of real‐life safety events. Results The 8 participating providers identified and mitigated an average of 5.5 out of 10 safety risks during the initial simulation, compared 7.4 safety risks at the follow up simulation (p=0.030). Two of the providers (25%) reported preventing at least one real‐world patient safety event in the clinical setting as a result of the initial training session. Conclusions Simulation‐based training may reduce providers’ susceptibility to chemotherapy ordering safety vulnerabilities within the EHR. This approach may be used when systems‐based EHR improvements are not feasible due to limited ability to customize local instances of proprietary EHR software.

Realistic simulation in the preparation and administration of medications: a systematic review

“…The twelve articles did not demonstrate the inclusion of patients, they involved the development of some teaching resource or creation of resources to reduce and prevent adverse drug events through simulation methods. Of these articles, 01 involved the creation of a freeze-dried ampoule of Dantrolene (Giraldo-Gutiérrez et al, 2018); 01 identified unreported errors (You et al, 2015); 02 studies developed drug labels for simulations (Dollinger et al, 2016;GARCIA, et al, 2017); 01 alert created in simulations, 2017); 01 created alerts in medication prescription software to avoid errors (RUSS et al, 2014); 01 used simulated software to verify medication orders and reconciliation by pharmacists (Metzger et al, 2015); 01 involved creating software to train on security vulnerabilities in chemotherapy orders (Wyatt et al, 2020); 01 created a gamification simulator for preparing medicines (Booth et al, 2018); 01 creation of a device for the infusion of intravenous medications after checking the barcode (Khan et al, 2016); an integrative review that shows that high and low fidelity simulations contribute to knowledge acquisition (Santana et al, 2020); one study compared the frequency of errors after safety simulation training (JONES et al, 2021); one developed a simulated electronic medication administration system (Booth et al, 2017).…”

“…The most frequent simulations are performed in high-fidelity laboratories (58%), using mannequins, labels, equipment and an environment prepared to get as close as possible to real care (Minor et al, 2019;Lane;Roberts, 2021;Kothari et al, 2021;O' Leary et al, 2013;Damhoff et al, 2014;Hayes et al, 2015;Keating et al, 2021;Raurell-Torredà et al, 2021;Russ et al, 2014;Hawley et al, 2019;Dudas;Barone, 2015;Stevens et al, 2015;Wyatt et al, 2020;Siebert et al, 2021;Adapa et al, 2012;booth et al, 2018;Breitkreuz et al, 2016;Estock et al, 2018;Enriquez et al, 2017;Prakash et al, 2014;Pinkney et al, 2014;VYAS et al, 2012;MERRY et al, 2017;GARCIA et al 2017;Metzger et al, 2015;Khan et al, 2016;Cooke et al, 2017;Pinkney et al, 2019;Frenzel et al, 2020;Hebbar et al, 2018;Cotteret et al, 2019;Porter et al, 2014;Wang et al, 2017;Booth et al, 2017;Lobos et al, 2019;Thibault et al, 2019;Crimmins et al, 2018;Berg et al, 2021).…”

“…Studies that used realistic simulation as a pedagogical resource were the most frequent corresponding to 37% of the systematic review. Scenarios involving adult patients are the most studied (43%) followed by pediatrics (21%), which suggests that more studies involving different scenarios with newborns, pregnant women and parturients can be carried out to know the adverse drug events (ADE) that affect these groups and thus make professionals and students aware of the weaknesses of this public little studied in simulated scenarios to study and involve all professional categories becomes of paramount importance in order to identify and prevent errors in each process (Minor, 2019;O' Leary et al, 2013;You et al, 2015;Edrich;Frendl, 2013;Alharbi et al, 2019a;Wyatt et al, 2020;Hanson et al, 2017;Pinkney et al, 2014;King et al, 2014;Frenzel et al, 2020;March et al, 2013;Hebbar et al, 2018;Crimmins et al, 2018;Metzger et al, 2015;Cotteret et al, 2019;Kothari et al, 2021;Wang et al, 2017;Momand;Dubrowski, 2020).…”