title: Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.
abstract: Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.
authors.affiliation: Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, and the Department of Clinical Pharmacy, University of Tennessee Health Science Center, Colleges of Pharmacy and Medicine, Memphis, Tennessee 38105, USA. James.Hoffman@stjude.org
authors.forename: James M
authors.initials: JM
authors.lastname: Hoffman
authors.forename: Donald K
authors.initials: DK
authors.lastname: Baker
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Laver
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Shenep
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D050316:Medical Order Entry Systems; D009369:Neoplasms / Q000188:drug therapy*; D014481:United States
chemical_list: D000970:Antineoplastic Agents