Bubalo Joseph, Warden Bruce A, Wiegel Joshua J, Nishida Tess, Handel Evelyn, Svoboda Leanne M, Nguyen Lam, Edillo P Neil
Department of Pharmacy Services, Oregon Health & Science University, OR, USA
Department of Pharmacy Services, Oregon Health & Science University, OR, USA.
J Oncol Pharm Pract. 2014 Dec;20(6):445-60. doi: 10.1177/1078155213514469. Epub 2013 Dec 19.
Medical errors, in particular medication errors, continue to be a troublesome factor in the delivery of safe and effective patient care. Antineoplastic agents represent a group of medications highly susceptible to medication errors due to their complex regimens and narrow therapeutic indices. As the majority of these medication errors are frequently associated with breakdowns in poorly defined systems, developing technologies and evolving workflows seem to be a logical approach to provide added safeguards against medication errors.
This article will review both the pros and cons of today's technologies and their ability to simplify the medication use process, reduce medication errors, improve documentation, improve healthcare costs and increase provider efficiency as relates to the use of antineoplastic therapy throughout the medication use process. Several technologies, mainly computerized provider order entry (CPOE), barcode medication administration (BCMA), smart pumps, electronic medication administration record (eMAR), and telepharmacy, have been well described and proven to reduce medication errors, improve adherence to quality metrics, and/or improve healthcare costs in a broad scope of patients. The utilization of these technologies during antineoplastic therapy is weak at best and lacking for most. Specific to the antineoplastic medication use system, the only technology with data to adequately support a claim of reduced medication errors is CPOE. In addition to the benefits these technologies can provide, it is also important to recognize their potential to induce new types of errors and inefficiencies which can negatively impact patient care.
The utilization of technology reduces but does not eliminate the potential for error. The evidence base to support technology in preventing medication errors is limited in general but even more deficient in the realm of antineoplastic therapy. Though CPOE has the best evidence to support its use in the antineoplastic population, benefit from many other technologies may have to be inferred based on data from other patient populations. As health systems begin to widely adopt and implement new technologies it is important to critically assess their effectiveness in improving patient safety.
医疗差错，尤其是用药差错，仍然是安全有效地提供患者护理过程中的一个棘手因素。由于抗肿瘤药物治疗方案复杂且治疗指数狭窄，它们是极易发生用药差错的一类药物。由于这些用药差错大多常与定义不清的系统故障相关，开发技术和改进工作流程似乎是一种合理的方法，可为防止用药差错提供额外保障。
本文将回顾当今技术的优缺点，以及它们在整个用药过程中使用抗肿瘤治疗时简化用药流程、减少用药差错、改善记录、降低医疗成本和提高医护人员效率的能力。几种技术，主要是计算机化医生医嘱录入（CPOE）、条形码给药（BCMA）、智能泵、电子给药记录（eMAR）和远程药学，已得到充分描述并被证明可减少用药差错，提高对质量指标的依从性，和/或在广泛的患者群体中降低医疗成本。在抗肿瘤治疗期间对这些技术的利用充其量很薄弱，大多数情况下甚至缺乏。针对抗肿瘤药物使用系统，唯一有数据充分支持减少用药差错说法的技术是CPOE。除了这些技术能带来的益处外，认识到它们可能引发新型差错和低效率，从而对患者护理产生负面影响，也很重要。
技术的使用减少但并未消除出错可能性。总体而言，支持技术预防用药差错的证据基础有限，在抗肿瘤治疗领域更是不足。尽管CPOE有最充分的证据支持其在抗肿瘤人群中的使用，但许多其他技术的益处可能不得不根据其他患者群体的数据来推断。随着卫生系统开始广泛采用和实施新技术，严格评估它们在提高患者安全方面的有效性很重要。
