Design, Implementation, and Evaluation of Compliance With Pharmacy Workflow During a Pediatric Oncology Computerized Provider Order Entry (CPOE) Launch

Abstract

There is a lack of published literature detailing how computerized physician order entry (CPOE) pharmacy workflow is designed and implemented. The intent of this project was to design, implement, and assess compliance with the pharmacy workflow required for launching CPOE to improve the safety and efficiency of chemotherapy order entry for pediatric patients. This process implementation project took place in 2 phases, which included the design and implementation of pharmacy workflow education, and retrospective chart review of patients who received chemotherapy ordered through CPOE. An anonymous survey was also distributed to pharmacy staff, nurses, and physicians, and an assessment of any CPOE-related safety reports was completed. Eighty-three patients received intravenous and/or intrathecal chemotherapy ordered via the CPOE software, Beacon, within the electronic medical record system, Epic, in the first 30 days post-launch across both the inpatient and outpatient settings. Overall compliance with the CPOE workflow for entering chemotherapy plans was 77% and >66% compliance with the order preparation process. Pharmacists provided an average of 1.6 interventions per review. The pharmacy was able to prepare chemotherapy within the allotted institutional time benchmarks in most cases. An overall combined multidisciplinary survey response rate of 30.6% was achieved. Twenty-eight Beacon-related patient safety reports were filed in the first 2 weeks post-launch. The Beacon launch at this single pediatric institution was successful, and the pharmacy workflow was shown to greatly affect the overall success of the launch of CPOE. The careful prospective design, education, implementation, and retrospective review of the pharmacy workflow is key to process implementation related to chemotherapy CPOE.