Safe chemotherapy: Clinicians driving technology and not the other way around.

Abstract

183 Background: Although information technology (IT) has the potential to improve the quality and safety of patient care, introduction into the clinical work flow may create unanticipated consequences. IT solutions such as computerized physician order entry (CPOE) are often designed and executed without end-user involvement. An evidence based guideline for systemic treatment (ST) CPOE was developed. The guideline looks at the features, functionalities and components of a ST CPOE system required to ensure safe and high-quality care. Methods: The guideline was developed by an interdisciplinary panel of physicians, nurses, pharmacists, methodologists, IT specialists, and human factors experts. A systematic review was conducted of the available clinical and technology literature and key informant interviews were conducted. Role-specific CPOE functionalities were process mapped for physicians, nurses and pharmacists. Two expert panels (i.e., clinical and supporting tools) were convened to review the information and provide feedback on guideline content. The guideline was also reviewed externally by content experts from provincial, national and international organizations. Results: The resulting evidence-based guideline focused on two distinct yet interconnected parts: clinical practice (e.g., error prevention, unanticipated consequences, impact on practice, clinical decision support), and technology requirements (e.g., usability features, system integration, effective alerts, audit logs, regimen building). The recommendations also highlight the importance of change management strategies and clinician engagement. Conclusions: This innovative guideline provides an approach to technology evaluation focusing on clinical practice needs driving IT solutions. Future research to help standardize design and usability of such systems is necessary. The non-vendor specific recommendations can be used as the foundation for evaluation of ST CPOE systems to reduce errors, improve safety, and support clinical practice. The application of the recommendations as an assessment of ST CPOE system guideline concordance will also be valuable.