Effect of computerized physician order entry (CPOE) on chemotherapy prescribing error.

Abstract

6034 Background: CPOE systems have previously been reported to reduce prescription error. There are few studies of CPOE in oncology practice. We studied the effect of replacing manual prescribing (MP) by a specialized chemotherapy CPOE system, ChemoCare, on prescribing error in a hematology-oncology practice in a comprehensive cancer center. Methods: All errors made during a 12-week period prior to CPOE implementation detected at routine pre-treatment pharmacy checks were categorized according to error type, and were scored for severity using the U.K. National Patient Safety Agency risk matrix by a panel of 4 blinded adjudicators (2 pharmacists and 2 doctors) working independently of each other; conflicts were resolved by a fifth adjudicator. Errors involving chemotherapy and supportive care with the exception of anti-infectives were analyzed. An identical exercise was conducted 15 months later, 6 months following completion of CPOE implementation. Results: A total of 49 of 251 (19.5%) of MP prescriptions contained an error compared to 14 of 272 (5.2%) of CPOE prescriptions, a 73% reduction (2p<0.0001, chi squared). The number of errors judged as major or potentially catastrophic fell by 50% whilst those of moderate severity fell by 81% with the use of CPOE (table). The drug dose error-rate was reduced by 74%, from 7.2% to 1.8% of prescriptions (2p=0.003), with a similar fall in error involving prescribing the wrong drug or wrong number of drug doses. There was a change in the nature of errors made with CPOE prescribing with 50% (7) arising from incorrect use of the system. These included 4 cases of zero drug doses arising from a failure to enter height and weight data. Conclusions: CPOE prescribing of chemotherapy offers a substantial improvement in patient safety. Error severity Catastrophic Major Moderate Minor None Total MP CPOE MP CPOE MP CPOE MP CPOE MP CPOE MP CPOE Wrong regimen 0 0 1 1 0 0 0 0 0 0 1 1 Wrong dose 1 0 6 2 10 3 0 0 1 0 18 5 Wrong number of doses 0 0 3 1 1 0 1 0 0 0 5 1 Missing or wrong drug 0 0 0 2 2 0 3 0 1 0 6 2 Supportive care error 0 0 0 0 4 1 5 4 3 0 12 5 Miscellaneous 0 0 1 0 4 0 2 0 0 0 7 0 Total 1 0 11 6 21 4 11 4 5 0 49 14 No significant financial relationships to disclose.