title: Reduction in chemotherapy order errors with computerized physician order entry.
abstract: OBJECTIVE
  To measure the number and type of errors associated with chemotherapy order composition associated with three sequential methods of ordering: handwritten orders, preprinted orders, and computerized physician order entry (CPOE) embedded in the electronic health record.
  
  
  METHODS
  From 2008 to 2012, a sample of completed chemotherapy orders were reviewed by a pharmacist for the number and type of errors as part of routine performance improvement monitoring. Error frequencies for each of the three distinct methods of composing chemotherapy orders were compared using statistical methods.
  
  
  RESULTS
  The rate of problematic order sets-those requiring significant rework for clarification-was reduced from 30.6% with handwritten orders to 12.6% with preprinted orders (preprinted v handwritten, P < .001) to 2.2% with CPOE (preprinted v CPOE, P < .001). The incidence of errors capable of causing harm was reduced from 4.2% with handwritten orders to 1.5% with preprinted orders (preprinted v handwritten, P < .001) to 0.1% with CPOE (CPOE v preprinted, P < .001).
  
  
  CONCLUSIONS
  The number of problem- and error-containing chemotherapy orders was reduced sequentially by preprinted order sets and then by CPOE. CPOE is associated with low error rates, but it did not eliminate all errors, and the technology can introduce novel types of errors not seen with traditional handwritten or preprinted orders. Vigilance even with CPOE is still required to avoid patient harm.
authors.affiliation: Anne Arundel Medical Center, Annapolis, MD.
authors.forename: Barry R
authors.initials: BR
authors.lastname: Meisenberg
authors.forename: Robert R
authors.initials: RR
authors.lastname: Wright
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Brady-Copertino
mesh_terms: D016303:Clinical Pharmacy Information Systems / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004360:Drug Therapy, Computer-Assisted / Q000379:methods / Q000706:statistics & numerical data*; D006236:Handwriting; D006801:Humans; D008495:Medical Oncology / Q000706:statistics & numerical data; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D008510:Medication Systems, Hospital / Q000706:statistics & numerical data; D009369:Neoplasms / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data