Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis.
OBJECTIVE
To implement and evaluate the impact of computerized provider order entry (CPOE) on reducing ordering errors in pediatric chemotherapy.


METHODS
Before-and-after study from 2001 to 2004.


METHODS
Pediatric Oncology in an academic medical center.


METHODS
Implementation of a CPOE system guided by multidisciplinary failure modes and effects analysis into pediatric chemotherapy.


METHODS
Completion data on chemotherapy steps of high morbidity/mortality potential if missed (as determined by attending oncologists) from 1259 pre-CPOE paper and 1116 post-CPOE pediatric chemotherapy orders.


RESULTS
After CPOE deployment, daily chemotherapy orders were less likely to have improper dosing (relative risk [RR], 0.26; 95% confidence interval [CI], 0.11-0.61), incorrect dosing calculations (RR, 0.09; 95% CI, 0.03-0.34), missing cumulative dose calculations (RR, 0.32; 95% CI, 0.14-0.77), and incomplete nursing checklists (RR, 0.51; 95% CI, 0.33-0.80). There was no difference in the likelihood of improper dosing on treatment plans and a higher likelihood of not matching medication orders to treatment plans (RR, 5.4; 95% CI, 3.1-9.5).


CONCLUSIONS
Failure modes and effects analysis-guided CPOE reduced ordering errors in pediatric chemotherapy and provided data for further improvements.
Kim
George R
GR
Division of Health Sciences Informatics, The Johns Hopkins School of Medicine, Baltimore, MD 21287-3200, USA. grkim@jhmi.edu
Chen
Allen R
AR
Arceci
Robert J
RJ
Mitchell
Sandra H
SH
Kokoszka
K Michelle
KM
Daniel
Denise
D
Lehmann
Christoph U
CU
D000046:Academic Medical Centers; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015142:Baltimore; D002648:Child; D016303:Clinical Pharmacy Information Systems / Q000458:organization & administration*; D004360:Drug Therapy, Computer-Assisted / Q000458:organization & administration*; D006801:Humans; D008485:Medical Audit; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D008508:Medication Errors / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy; D010348:Patient Care Team; D014584:User-Computer Interface
D000970:Antineoplastic Agents