Safe chemotherapy administration: Using failure mode and effects analysis in computerized prescriber order entry

Abstract

ProblemComputerized prescriber order entry (CPOE) has enabled many institutions to meet a changing and challenging health care market by altering how medications are processed. 1 Over the past several years, patient safety has become a key issue for all health care institutions, with serious questions and public concerns having been raised regarding medical errors. 2 Medication errors are of particular concern because of their increasing occurrence and preventable nature. Of the top 10 causes of death, medication errors ranked number 5 in 1999. 2 Although opportunities for medication errors exist at every stage of the medication-use process, the majority of errors are made during the ordering stage. 3,4 The Hospital of Saint Raphael in New Haven, Connecticut, implemented CPOE to enhance patient safety for medication management, but a decision was made to exclude i.v. chemotherapy drugs from the system because the CPOE system did not meet all of the requirements for safe chemotherapy administration. Specifically, the limited functionality of the i.v. medication administration record for large-volume parenterals and the associated electronic medication record did not provide a visual sequencing of events for safe chemotherapy administration.However, new safety concerns emerged as a result of this decision. The administration and documentation of i.v. chemotherapy by the nursing staff were based on handwritten orders that were transcribed by the nurse onto a paper medication administration record. To maintain a comprehensive pharmacy medication profile, all handwritten i.v. chemotherapy orders were subsequently entered into the CPOE system by the pharmacist for the provider. Due to system requirements, this information was automatically fed into the existing electronic MAR. The use of disparate databases for patient medication records resulted in several variances in patient medication records. As a result, a decision was made to thoroughly examine all the processes involved in chemotherapy ordering and administration using failure mode and effects analysis (FMEA). Analysis and resolutionFMEA uses a team approach to assess processes for efficiency and effectiveness and identify and prevent process failures. It is commonly used in the manufacturing, aviation, and computer software design industries. Within health care, FMEA is designed to decrease the likelihood of adverse events that may jeopardize the health and safety of patients. 5 The FMEA model we used was based on a model developed by Spath. 6 After identifying the high-risk patient care process to be reviewed (the ordering and administration of chemotherapy and adjuvant drugs), a nine-member, multidisciplinary team was formed, consisting of (1) a team leader, (2) a team advisor with FMEA experience, (3) a recorder, (4) a clinical pharmacist, (5) an oncology nurse manager, (6) a staff oncology nurse, (7) an onManagement Case Studies describe approaches to real-life management problems in health systems. Each installment is a brief description of a problem and ...

Is Failure Mode and Effect Analysis Reliable?

“…Previous studies have chosen to address failures with the highest 5 RPN, 2,14 the highest 6 RPN, 15 or even their highest 30 RPN scores. 16 Other studies have addressed failures with an RPN greater than the mean, 17 whereas others have specified a cutoff point for RPN at which any failures with an RPN higher than the cutoff point would be addressed. 18,19 The difference between the 2 groups in our study is particularly dramatic if this last method is used.…”

Computerized Prescriber Order Entry in the Outpatient Oncology Setting: From Evidence to Meaningful Use

“…One qualitative study pertaining to the impact of cpoe on oncology practice was identified 24 . In a failure mode and effects analysis conducted with a multidisciplinary team, the team was able to affect practice by developing a uniform and safe chemotherapy ordering system.…”

Specifications of Computerized Provider Order Entry and Clinical Decision Support Systems for Cancer Patients Undergoing Chemotherapy: A Systematic Review

“…The hospital workflow support system was proposed in 15 papers [34, 36, 37, 42, 44-47, 51, 54, 57, 58, 70, 74, 75]. Documentation and reporting specifications were discussed in 12 articles [35,40,42,46,57,58,[63][64][65][66][67][68]; specifications associated with drug safety were listed in 12 articles [34,40,42,45,54,56,60,63,64,66,70,74]; system communication and information security specifications were also debated in 8 [40,48,49,55,57,61,64,70] and 7 [39,44,45,55,61,63,68] papers, respectively.…”