Enhancing the effectiveness of chemotherapy prescribing: A validation study of ChemoPalRx.

Abstract

e19161 Background: ChemoPalRx is a free iOS mobile application developed for chemotherapy referencing and prescribing. Providers can readily download and use ChemoPalRx to generate and print chemotherapy formatted prescriptions. In the absence of a computerized chemotherapy order entry system, institutions may adopt ChemoPalRx for chemotherapy prescribing in place of traditional methods such as handwritten prescriptions. However, effectiveness of ChemoPalRx in the real-world practices has not been established. Methods: With our aim to determine the effectiveness of ChemoPalRx, we conducted a cross sectional study at an academic institution. Our study primary predictor was the method of generating a chemotherapy order, dichotomized as “handwritten” or “ChemoPalRx”. Primary outcome was corrected order, dichotomized as “corrected” or “satisfactory” order. Corrections were defined as any correction made to an order (e.g. illegible handwriting, modifications in drug dosing, missing chemotherapy or patient’s information). Covariates included fellowship training year (first, second, or third) and complexity of order (“simple” = 2 drugs or less; “complex” = 3 drugs or more). Correction rate (CR) was defined as the proportion of corrected orders. Chi Square test was used for statistical analysis. Results: From October 2019 to December 2019, 288 chemotherapy orders were examined, of which, 226 were handwritten (78.5%) and 62 were ChemoPalRx (21.5%). Of the 226 handwritten orders, 184 (81%) were satisfactory, 42 (19%) were corrected. Of the 62 ChemoPalRx orders, 57 (92%) were satisfactory, 5 (8%) were corrected. CR was significantly reduced by ChemoPalRx compared to handwritten (p = 0.034). Subgroup analysis found that first-year fellows tend to make more corrections on complex orders (CR: 19%) compared to second- and third-year fellows (CR: 6%) (p = 0.19), while second- and third- year fellows made more corrections on simple orders (CR: 22%) compared to first-year fellows (CR: 9%) (p = 0.013). Conclusions: ChemoPalRx significantly enhanced prescription accuracy compared to handwritten chemotherapy orders. Implementation of ChemoPalRx in real-world practices is validly feasible and effective. While ChemoPalRx may support less experienced providers on more complex orders, it may help to catch overlooked simple details for the experienced providers. In the evolving digital era in oncology, ChemoPalRx may be a promising alternative to handwritten prescriptions that can be readily available at one’s fingertips.