title: Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis.
abstract: 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.
authors.affiliation: Division of Health Sciences Informatics, The Johns Hopkins School of Medicine, Baltimore, MD 21287-3200, USA. grkim@jhmi.edu
authors.forename: George R
authors.initials: GR
authors.lastname: Kim
authors.forename: Allen R
authors.initials: AR
authors.lastname: Chen
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Arceci
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Mitchell
authors.forename: K Michelle
authors.initials: KM
authors.lastname: Kokoszka
authors.forename: Denise
authors.initials: D
authors.lastname: Daniel
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Lehmann
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents