Abstract
BackgroundChemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used.MethodsUp to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale.ResultsEight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome.ConclusionsChemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.
Highlights
Examples included patient or medication selection errors due to fragmented Computerized physician order entry (CPOE) displays preventing a coherent view of patients’ details and medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, medication discontinuation failures, immediate orders and pro re nata (PRN) medication discontinuation faults, double dosing and incompatible orders facilitated by separation of functions, and wrong orders due to inflexible ordering formats
Little is known on the type and frequency of prescribing errors in cancer patients and there is no conclusive evidence that information technology (IT) may exert any specific influence over them
The main aim of the present study was to evaluate the frequency of chemotherapy prescribing errors in an Oncology outpatient unit equipped with a CPOE system
Summary
In the American Society of Health-System Pharmacists (ASHP) 2002 guidelines on preventing chemotherapy prescribing errors, CPOE systems are claimed to offer superior results over pre-printed prescription forms, due to additional features such as the removal of interpretation/transcription errors, the availability of information about drug doses/schedules, the automatic calculation of medication doses, as well as alert and error-checking functions [4]. Few studies have investigated the impact of computerized systems on the reduction of medication errors in oncology; most evidence comes from other specialties or is derived from data about the use of standardized paper prescription forms. Little is known on the type and frequency of prescribing errors in cancer patients and there is no conclusive evidence that information technology (IT) may exert any specific influence over them
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