Background Antineoplastic agents are considered high risk medications due to their narrow therapeutic window and high toxicity. The workflow of the chemotherapy process is complex, with prescribing, ordering, reconstituting and administering of drugs occurring in distinct steps. Computerised physician order entries (CPOE) are commonly introduced to improve medication safety but the adoption of a computerised system may elicit novel medication errors (ME) and safety risks.
Purpose To evaluate the impact of implementation of a CPOE on medication errors in chemotherapy within a tertiary care university hospital (inpatients and outpatients).
Material and methods The retrospective comparative study with before-after design was conducted in the cancer centre and the hospital pharmacy cytotoxic unit of a large university hospital district in Finland. In total, 1199 medication related reports from a safety incident reporting system were reviewed before (12 months) and after the adoption of CPOE (12 months, starting 9 months after implementation). Of them, all reports involving parenteral chemotherapy were selected for this study (n = 216, before n = 85; after n = 131). Types and number of reported medication errors were studied. Qualitative analysis evaluated the influence of CPOE on the nature of errors and the functionality of safety barriers during prescribing, ordering and delivering parenteral antineoplastic agents.
Results The total number of medication error reports in the cancer centre did not differ between the 1 year study periods before and after adoption of CPOE (n = 77 vs n = 68, respectively). Of all the reported medication errors involving a chemotherapy agent (n = 216), 27% occurred during planning of treatment and prescribing, 14% during ordering and 21% during processing of the order and delivery. Use of CPOE was associated with a ˜50% reduction in reported dose errors which occurred during ordering of parenteral antineoplastic agents. Safety incident reports involving a prescribing error were not reduced and, notably, the number of non-intercepted prescription dose errors was increased compared with the manual process (n = 11 vs n = 5, respectively).
Conclusion Adoption of CPOE has the potential to alter the occurrence and type of medication errors. It is crucial to identify the pitfalls of a computerised system and develop adequate barriers to prevent novel types of errors from reaching the patient.
No conflict of interest.
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