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Srinivasamurthy SK, Ashokkumar R, Kodidela S, Howard SC, Samer CF, Chakradhara Rao US. Impact of computerised physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review. Eur J Clin Pharmacol 2021; 77:1123-1131. [PMID: 33624119 PMCID: PMC8275496 DOI: 10.1007/s00228-021-03099-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/28/2021] [Indexed: 11/04/2022]
Abstract
Purpose Computerised prescriber (or physician) order entry (CPOE) implementation is one of the strategies to reduce medication errors. The extent to which CPOE influences the incidence of chemotherapy-related medication errors (CMEs) was not previously collated and systematically reviewed. Hence, this study was designed to collect, collate, and systematically review studies to evaluate the effect of CPOE on the incidence of CMEs. Methods A search was performed of four databases from 1 January 1995 until 1 August 2019. English-language studies evaluating the effect of CPOE on CMEs were selected as per inclusion and exclusion criteria. The total CMEs normalised to total prescriptions pre- and post-CPOE were extracted and collated to perform a meta-analysis using the ‘meta’ package in R. The systematic review was registered with PROSPERO CRD42018104220. Results The database search identified 1621 studies. After screening, 19 studies were selected for full-text review, of which 11 studies fulfilled the selection criteria. The meta-analysis of eight studies with a random effects model showed a risk ratio of 0.19 (95% confidence interval: 0.08–0.44) favouring CPOE (I2 = 99%). Conclusion The studies have shown consistent reduction in CMEs after CPOE implementation, except one study that showed an increase in CMEs. The random effects model in the meta-analysis of eight studies showed that CPOE implementation reduced CMEs by 81%. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-021-03099-9.
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Affiliation(s)
- Suresh Kumar Srinivasamurthy
- Department of Pharmacology, Ras Al Khaimah College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Ramkumar Ashokkumar
- Cancer Services Business Informatics, Helen Diller Family Comprehensive Cancer, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Sunitha Kodidela
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Scott C Howard
- Department of Acute and Critical Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Caroline Flora Samer
- Division of Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Rahimi R, Moghaddasi H, Rafsanjani KA, Bahoush G, Kazemi A. Effects of chemotherapy prescription clinical decision-support systems on the chemotherapy process: A systematic review. Int J Med Inform 2019; 122:20-26. [DOI: 10.1016/j.ijmedinf.2018.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 10/09/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
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Jeon J, Taneva S, Kukreti V, Trbovich P, Easty AC, Rossos PG, Cafazzo JA. Toward successful migration to computerized physician order entry for chemotherapy. ACTA ACUST UNITED AC 2014; 21:e221-8. [PMID: 24764707 DOI: 10.3747/co.21.1759] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Computerized physician order entry (cpoe) systems allow for medical order management in a clinical setting. Use of a cpoe has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Usability of these systems has been identified as a critical factor in their successful adoption. However, there is a paucity of literature investigating the usability of cpoe for chemotherapy and describing the experiences of cancer care providers in implementing and using a cpoe system. METHODS A mixed-methods study, including a national survey and a workshop, was conducted to determine the current status of cpoe adoption in Canadian oncology institutions, to identify and prioritize knowledge gaps in cpoe usability and adoption, and to establish a research agenda to bridge those gaps. Survey respondents were representatives of cancer care providers from each Canadian province. The workshop participants were oncology clinicians, human factors engineers, patient safety researchers, policymakers, and hospital administrators from across Canada, with participation from the United States. RESULTS A variety of issues related to implementing and using a cpoe for chemotherapy were identified. The major issues concerned the need for better understanding of current practices of chemotherapy ordering, preparation, and administration; a lack of system selection and procurement guidance; a lack of implementation and maintenance guidance; poor cpoe usability and workflow support; and other cpoe system design issues. An additional three research themes for addressing the existing challenges and advancing successful adoption of cpoe for chemotherapy were identified: The need to investigate variances in workflows and practices in chemotherapy ordering and administrationThe need to develop best-practice cpoe procurement and implementation guidance specifically for chemotherapyThe need to measure the effects of cpoe implementation in medical oncology. CONCLUSIONS Addressing the existing challenges in cpoe usability and adoption for chemotherapy, and accelerating successful migration to cpoe by cancer care providers requires future research focusing on workflow variations, chemotherapy-specific cpoe procurement needs, and implementation guidance needs.
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Affiliation(s)
- J Jeon
- Healthcare Human Factors, University Health Network, Toronto, ON
| | - S Taneva
- Healthcare Human Factors, University Health Network, Toronto, ON
| | - V Kukreti
- Department of Medical Oncology and Hematology, University Health Network, Toronto, ON. ; Department of Medical Oncology and Hematology, University of Toronto, Toronto, ON
| | - P Trbovich
- HumanEra, University Health Network, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON. ; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON
| | - A C Easty
- HumanEra, University Health Network, Toronto, ON. ; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON
| | - P G Rossos
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON. ; Department of Medicine, University of Toronto, Toronto, ON
| | - J A Cafazzo
- Healthcare Human Factors, University Health Network, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON. ; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON
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Aita M, Belvedere O, De Carlo E, Deroma L, De Pauli F, Gurrieri L, Denaro A, Zanier L, Fasola G. Chemotherapy prescribing errors: an observational study on the role of information technology and computerized physician order entry systems. BMC Health Serv Res 2013; 13:522. [PMID: 24344973 PMCID: PMC3878514 DOI: 10.1186/1472-6963-13-522] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used. METHODS Up to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale. RESULTS Eight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome. CONCLUSIONS Chemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.
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Affiliation(s)
- Marianna Aita
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Ornella Belvedere
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
- Department of Oncology, York Teaching Hospital, York, UK
| | - Elisa De Carlo
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Laura Deroma
- Regional Coordinator Centre for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Federica De Pauli
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Lorena Gurrieri
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Angela Denaro
- Department of Medical Oncology, University Hospital of Trieste, Trieste, Italy
| | - Loris Zanier
- Health Directorate, Friuli Venezia-Giulia Region, Trieste, Italy
| | - Gianpiero Fasola
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
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Abstract
Electronic-Prescribing, Computerized Prescribing, or E-RX has increased dramatically of late in the American health care system, a long overdue alternative to the written form for the almost five billion drug treatments annually. This paper examines the history and selected issues in the rise of E-RX by a review of salient literature, interviews, and field observations in Pharmacy. Pharmacies were early adopters of computerization for a variety of factors. The profession in its new corporate forms of chain drug stores and pharmacy benefits firms has sought efficiencies, profit enhancements, and clinical improvements through managed care strategies that rely upon data automation. E-RX seems to be a leading factor in overall physician acceptance of Electronic Medical Records (EMRs), although the Centers for Medicare and Medicaid (CMS) incentives seem to be the propelling force in acceptance. We conclude that greater research should be conducted by public health professionals to focus on resolutions to pharmaceutical use, safety, and cost escalation, which persist and remain dire following health reform.
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Wolfe TE. Making the Case for Electronic Health Records: A Report From ASCO's EHR Symposium. J Oncol Pract 2011; 4:41-2. [PMID: 20859442 DOI: 10.1200/jop.0817001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Carrington C, Stone L, Koczwara B, Searle C, Siderov J, Stevenson B, Michael M, Hyde S, Booth A, Rushton S. The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy. Asia Pac J Clin Oncol 2011; 6:220-37. [PMID: 20887505 DOI: 10.1111/j.1743-7563.2010.01321.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The issue of medication safety is highly significant when anti-cancer therapy is used as a treatment modality due to the high potential for harm from these agents and the disease context in which they are being used. These guidelines provide recommendations on the safe prescribing, dispensing and administration of chemotherapy and related agents used in the treatment of cancer. The guidelines represent a multidisciplinary collaboration to standardise the complex process of providing chemotherapy for cancer and to enhance patient safety. These are consensus guidelines based on the best available evidence and expert opinion of professionals working in cancer care. The aim of these guidelines is to assist in the prevention of medication errors and to improve patient safety with respect to the treatment of cancer. This guidance is intended for a multi-disciplinary audience and will have most relevance for medical, nursing and pharmacy staff involved in the complex processes of delivering chemotherapy and associated treatment. The scope of the guidelines includes; all patients and age groups receiving chemotherapy and targeted therapy for the treatment of cancer and cancer therapy administered by any route in both the hospital and home setting. These guidelines should be seen as point of reference for practitioners providing cancer chemotherapy services.
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Affiliation(s)
- Christine Carrington
- Division of Cancer, Princess Alexandra Hospital/Cancer Control Team, Brisbane, Queensland, Australia.
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Shulman LN, Miller RS, Ambinder EP, Yu PP, Cox JV. Principles of Safe Practice Using an Oncology EHR System for Chemotherapy Ordering, Preparation, and Administration, Part 2 of 2. J Oncol Pract 2008; 4:254-257. [PMID: 29452528 DOI: 10.1200/jop.0857501] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Integrating electronic health records into the oncology office, while taking into consideration the principles of electronic health record usage, is a great way to improve the chemotherapy ordering and administration process.
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Affiliation(s)
- Lawrence N Shulman
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
| | - Robert S Miller
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
| | - Edward P Ambinder
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
| | - Peter Paul Yu
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
| | - John V Cox
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
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Shulman LN, Miller RS, Ambinder EP, Yu PP, Cox JV. Principles of Safe Practice Using an Oncology EHR System for Chemotherapy Ordering, Preparation, and Administration, Part 1 of 2. J Oncol Pract 2008; 4:203-206. [PMID: 29447501 PMCID: PMC2793944 DOI: 10.1200/jop.0847501] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An outline of broad principles that should be considered when integrating an electronic health record, and in particular, a chemotherapy ordering module, into practice.
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Affiliation(s)
- Lawrence N Shulman
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento, CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; and Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
| | - Robert S Miller
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento, CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; and Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
| | - Edward P Ambinder
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento, CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; and Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
| | - Peter Paul Yu
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento, CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; and Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
| | - John V Cox
- Dana-Farber Cancer Institute, Boston, MA; Sacramento Center for Hematology and Medical Oncology, Sacramento, CA; Mount Sinai School of Medicine, New York, NY; Palo Alto Medical Foundation, Mountain View, CA; and Texas Oncology Methodist Dallas Cancer Center, Dallas, TX
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