Using an enhanced oral chemotherapy computerized provider order entry system to reduce prescribing errors and improve safety.

OBJECTIVE

To reduce the probability of failure in the oral chemotherapy order, review and administration process and to reduce oral chemotherapy-related prescribing errors intercepted by clinical pharmacists prior to reaching the patient.

DESIGN

A before-and-after cohort study.

SETTING

A 719-bed multidisciplinary tertiary care institution with a pediatric division and an outpatient cancer center.

PARTICIPANTS

A multidisciplinary team characterized key elements of the oral chemotherapy process using healthcare failure modes and effects analysis (HFMEA).

INTERVENTION(S): Oral chemotherapy computerized provider order entry (CPOE) was developed and implemented.

MAIN OUTCOME MEASURE(S): Pharmacist-intercepted oral chemotherapy prescribing errors over a 24-month period (before) and over a 6-month period (after) were analyzed according to the error type (errors in clinical decision making, errors in transcription or errors related to prescribing policy). The incidence of prescribing errors prior to and following CPOE implementation was compared by calculating the odds ratio (OR) and the 95% confidence interval (CI).

RESULTS

HFMEA hazard analysis revealed seven potential failure modes, with the highest hazard scores in the prescribing and administration components of the process. CPOE implementation significantly (P= 0.023) reduced prescribing error risk by 69% [OR (95% CI) = 0.31 (0.11-0.86)] and eliminated certain types of errors that can lead to significant patient harm.

CONCLUSIONS

Prescribing oral chemotherapy is a failure mode with significant risk of inducing patient harm. CPOE is effective in reducing prescribing errors of oral chemotherapy and should be considered part of a fail-safe process to improve safety.