Abstract
Chemotherapy is an effective treatment in the fight against many cancers. Medication errors in oncology can be particularly serious given the narrow therapeutic window of antineoplastic drugs and their high toxicities. Computerized prescriber order entry (cpoe) has consistently been shown to reduce medication errors and adverse drug events in various settings, but its use in the oncology setting has not been well established. To gain a better understanding of the meaningful use of cpoe systems in the outpatient chemotherapy setting, we undertook a systematic review of systemic therapy cpoe. A province-wide expert panel consisting of clinical experts, health information professionals, and specialists in human factors design provided guidance in the development of the research questions, search terms, databases, and inclusion criteria. The systematic review was undertaken by a core team consisting of a medical oncologist, nurse, pharmacist, and methodologist. The medline, embase, cinahl, and compendex databases were searched for relevant evidence. The database searches resulted in 5642 hits, of which 9 met the inclusion criteria and were retained. In the oncology setting, cpoe systems generally reduce chemotherapy medication errors; however, specific types of errors increase with the use of cpoe. These systems affect practice both positively and negatively with respect to time, workload, and productivity. Despite the paucity of oncology-specific research, cpoe should be used in outpatient chemotherapy delivery to reduce chemotherapy-related medication errors. Adoption by clinicians will be enhanced by cpoe processes that complement current practice and workflow processes.
Highlights
Chemotherapy is an effective treatment in the fight against many cancers
Cpoe systems generally reduce chemotherapy medication errors; specific types of errors increase with the use of cpoe
Despite the paucity of oncology-specific research, cpoe should be used in outpatient chemotherapy delivery to reduce chemotherapy-related medication errors
Summary
Chemotherapy is an effective treatment in the fight against many cancers. Medication errors in oncology can be serious given the narrow therapeutic window of antineoplastic drugs and their high toxicities. Computerized prescriber order entry (cpoe) has consistently been shown to reduce medication errors and adverse drug events in various settings, but its use in the oncology setting has not been well established. Medication errors in oncology can be serious, given the narrow therapeutic window and the high toxicities of antineoplastic drugs[4,5]. In a study conducted by Leape et al.[6] of adverse drug events, 39% of errors occurred in the physician order phase, with drug dosing accounting for 28% of all errors. A study of outpatient care in the oncology setting found that 7% of adult visits and 19% of pediatric visits were associated with a medication error, either in the clinic or at home[8]. Serious consequences can follow from even a small difference in the intended dose: overdosing can result in considerably more toxicity than usual, and underdosing can result in an unfavourable therapeutic outcome[5]
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