Elsaid Khaled A, Garguilo Steven, Collins Christine M
Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA.
Pharmacy Services, Rhode Island Hospital, Providence, RI, USA.
Integr Pharm Res Pract. 2015 May 21;4:39-48. doi: 10.2147/IPRP.S84232. eCollection 2015.
Chemotherapy drugs are characterized by low therapeutic indices and significant toxicities at clinically prescribed doses, raising serious issues of drug safety. The safety of the chemotherapy medication use process is further challenged by regimen complexity and need to tailor treatment to patient status. Errors that occur during chemotherapy prescribing are associated with serious and life-threatening outcomes. Computerized provider order entry (CPOE) systems were shown to reduce overall medication errors in ambulatory and inpatient settings. The adoption of chemotherapy CPOE is lagging due to financial cost and cultural and technological challenges. Institutions that adopted infusional or oral chemotherapy electronic prescribing modified existing CPOE systems to allow chemotherapy prescribing, implemented chemotherapy-specific CPOE systems, or developed home-grown chemotherapy electronic prescribing programs. Implementation of chemotherapy electronic prescribing was associated with a significant reduction in the risk of prescribing errors, most significantly dose calculation and adjustment errors. In certain cases, implementation of chemotherapy CPOE was shown to improve the chemotherapy use process. The implementation of chemotherapy CPOE may increase the risk of new types of errors, especially if processes are not redesigned and adapted to CPOE. Organizations aiming to implement chemotherapy CPOE should pursue a multidisciplinary approach engaging all stakeholders to guide system selection and implementation. Following implementation, organizations should develop and use a risk assessment process to identify and evaluate unanticipated consequences and CPOE-generated errors. The results of these analyses should serve to further enhance the chemotherapy electronic prescribing process and improve the quality and safety of cancer care.
化疗药物的特点是治疗指数低，在临床规定剂量下具有显著毒性，这引发了严重的药物安全问题。化疗用药过程的安全性还受到治疗方案复杂性以及需要根据患者状况量身定制治疗方案的挑战。化疗处方过程中出现的错误与严重的、危及生命的后果相关。计算机化医嘱录入（CPOE）系统已被证明可减少门诊和住院环境中的总体用药错误。由于财务成本以及文化和技术挑战，化疗CPOE的采用滞后。采用静脉输注或口服化疗电子处方的机构对现有的CPOE系统进行了修改以允许开具化疗处方，实施了特定于化疗的CPOE系统，或开发了自行研制的化疗电子处方程序。化疗电子处方的实施与处方错误风险的显著降低相关，最显著的是剂量计算和调整错误。在某些情况下，化疗CPOE的实施被证明可改善化疗使用过程。化疗CPOE的实施可能会增加新型错误的风险，尤其是在流程未重新设计且未适应CPOE的情况下。旨在实施化疗CPOE的组织应采用多学科方法，让所有利益相关者参与进来，以指导系统的选择和实施。实施后，组织应制定并使用风险评估流程，以识别和评估意外后果以及CPOE产生的错误。这些分析结果应有助于进一步完善化疗电子处方流程，提高癌症护理的质量和安全性。
