Effect of a cancer chemotherapy prescription form on prescription completeness

Abstract

Completeness of physicians' orders for cancer chemotherapy was compared before and after implementation of a preprinted form for these orders. When an oncology pharmacy service (OPS) in which pharmacy prepared all drugs for cancer chemotherapy was implemented in 1985 at an 879-bed teaching hospital, the pharmacists began educational sessions for house-staff physicians on writing orders for cancer chemotherapy. Pharmacists assessed the effectiveness of these sessions by comparing completeness of orders written before implementation of the OPS with orders during a four-week period starting two months after implementation. Orders were checked for nine components: patient's diagnosis, height, weight, and body surface area and drug regimen, dose, dosage, frequency, and route. Inclusion of the same components was assessed after implementation of a form that physicians were required to use for prescribing all antineoplastic agents. During the baseline period, orders for 143 patients were evaluated. Only two prescription components, dose and route, were present is more than 90% of the orders. Educational intervention led to some improvement in order completeness, but only dose and route appeared in at least 90% of the 87 orders evaluated. The components necessary to verify physicians' calculations for body surface area and dose--height, weight, and dosage--were absent in 29 of the orders, and a pharmacist spent 420 minutes clarifying them. After the order form was implemented, orders for 77 patients were reviewed. Compliance exceeded 90% for eight of the nine components, and 12 medication errors were prevented by the form. A pharmacist spent 70 minutes clarifying five orders.(ABSTRACT TRUNCATED AT 250 WORDS)