Effect of computerisation on the quality and safety of chemotherapy prescription.
BACKGROUND
Chemotherapy is prescribed according to protocols of several cycles. These protocols include not only therapeutic agents but also adjuvant solvents and inherent supportive care measures. Multiple errors can occur during the prescription, the transmission of documents and the drug delivery processes, and lead to potentially serious consequences.


OBJECTIVE
To assess the effect of a computerised physician order entry (CPOE) system on the number of errors in prescription recorded by the centralised chemotherapy unit of a pharmacy service in a university hospital.


METHODS
Existing chemotherapy protocols were standardised by a multidisciplinary team (composed of a doctor, a pharmacist and a nurse) and a CPOE system was developed from a File Maker Pro database. Chemotherapy protocols were progressively introduced into the CPOE system. The effect of the system on prescribing errors was measured over 15 months before and 21 months after starting computerised protocol prescription. Errors were classified as major (dosage and drug name) and minor (volume or type of infusion solution).


RESULTS
Before computerisation, 141 errors were recorded for 940 prescribed chemotherapy regimens (15%). After introduction of the CPOE system, 75 errors were recorded for 1505 prescribed chemotherapy regimens (5%). Of these errors, 69 (92%) were recorded in prescriptions that did not use a computerised protocol. A dramatic decrease in the number of errors was noticeable when 50% of the chemotherapy protocols were prescribed through the CPOE system.


CONCLUSIONS
Errors in chemotherapy prescription nearly disappeared after implementation of CPOE. The safety of chemotherapy prescription was markedly improved.
Voeffray
Marc
M
Pharmacy Service, University Hospital, Lausanne, Switzerland.
Pannatier
André
A
Stupp
Roger
R
Fucina
Nadia
N
Leyvraz
Serge
S
Wasserfallen
Jean-Blaise
JB
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D016303:Clinical Pharmacy Information Systems; D002985:Clinical Protocols; D011307:Drug Prescriptions; D004360:Drug Therapy, Computer-Assisted; D006236:Handwriting; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008510:Medication Systems, Hospital / Q000592:standards*; D009369:Neoplasms / Q000188:drug therapy*; D010607:Pharmacy Service, Hospital / Q000592:standards*; D011785:Quality Assurance, Health Care; D017751:Safety Management; D013557:Switzerland
D000970:Antineoplastic Agents