Vosters Olivier, Jaadar Youssef, Vidts Laure-Anne, Demols Anne, Lorent Sophie, Liévin Viviane, Demoulin Marc
Department of Pharmacy, Erasme Hospital, 808 Route de Lennik, Brussels, Belgium.
Department of Gastro-enterology, Erasme Hospital, 808 Route de Lennik, Brussels, Belgium.
Eur J Hosp Pharm. 2018 Sep;25(5):281-285. doi: 10.1136/ejhpharm-2016-001135. Epub 2017 May 9.
Cancer chemotherapy drugs are classified as high-risk molecules. Safety of the cancer chemotherapy process is often achieved with the implementation of a health information technology to each step or to the entire process. However, computerisation could lead to the emergence of new unintended medication errors. The aim of the study was to evaluate the impact of new software designed for the management of anticancer chemotherapies.
The cartography of the process and the failure modes, effects and criticality analysis were performed by a multidisciplinary team. Criticality indexes were calculated considering or not the implementation of the commercial software (CytoWeb). Quality and satisfactory indicators were measured before the implementation and during the use of the software.
Our results demonstrated the complexity of the cancer chemotherapy process in the hospital. Risk analysis highlighted the positive impact of CytoWeb on the process safety but pointed out some steps that were not positively influenced by the software. Although a decrease of 38.6% of error rate was observed with the electronic system, new unintended medication errors emerged. These errors were due to inadequate use of the software (encoding of the wrong drug, the wrong dose, the wrong patient parameters or lab results and lack of prescriber adherence). Our satisfaction survey showed that the hospital pharmacists and doctors were less satisfied by the software than the nurses, mostly in terms of task achievement and time saving. Survey's results highlighted some weaknesses in the user training and in the collaboration between the medical staff.
Our work showed the emergence of unintended medication errors linked to computerisation that were due to an inadequate use of the software. Other issues were highlighted such as the lack of collaboration between the medical staff, the lack of prescriber implication and weaknesses in the user training or in the information related to CytoWeb.
癌症化疗药物被归类为高风险分子。癌症化疗过程的安全性通常通过在每个步骤或整个过程中实施健康信息技术来实现。然而，计算机化可能会导致新的意外用药错误出现。本研究的目的是评估为抗癌化疗管理设计的新软件的影响。
由一个多学科团队进行流程制图以及失效模式、影响及危害性分析。在考虑或不考虑商业软件（CytoWeb）实施的情况下计算关键性指标。在软件实施前和使用期间测量质量和满意度指标。
我们的结果表明了医院中癌症化疗过程的复杂性。风险分析突出了CytoWeb对流程安全性的积极影响，但也指出了一些未受到软件积极影响的步骤。尽管电子系统使错误率降低了38.6%，但仍出现了新的意外用药错误。这些错误是由于软件使用不当（错误药物编码、错误剂量、错误患者参数或实验室结果以及开处方者未遵守规定）。我们的满意度调查显示，医院药剂师和医生对该软件的满意度低于护士，主要体现在任务完成情况和节省时间方面。调查结果突出了用户培训以及医务人员之间协作方面的一些弱点。
我们的工作表明，与计算机化相关的意外用药错误的出现是由于软件使用不当。还突出了其他问题，如医务人员之间缺乏协作、开处方者参与不足、用户培训方面的弱点或与CytoWeb相关信息方面的弱点。
