title: Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis.
abstract: OBJECTIVE
  To evaluate the impact of electronic standardized chemotherapy templates on incidence and types of prescribing errors.
  
  
  METHODS
  A quasi-experimental interrupted time series with segmented regression.
  
  
  METHODS
  A 700-bed multidisciplinary tertiary care hospital with an ambulatory cancer center.
  
  
  METHODS
  A multidisciplinary team including oncology physicians, nurses, pharmacists and information technologists.
  
  
  METHODS
  Standardized, regimen-specific, chemotherapy prescribing forms were developed and implemented over a 32-month period.
  
  
  METHODS
  Trend of monthly prevented prescribing errors per 1000 chemotherapy doses during the pre-implementation phase (30 months), immediate change in the error rate from pre-implementation to implementation and trend of errors during the implementation phase. Errors were analyzed according to their types: errors in communication or transcription, errors in dosing calculation and errors in regimen frequency or treatment duration. Relative risk (RR) of errors in the post-implementation phase (28 months) compared with the pre-implementation phase was computed with 95% confidence interval (CI).
  
  
  RESULTS
  Baseline monthly error rate was stable with 16.7 prevented errors per 1000 chemotherapy doses. A 30% reduction in prescribing errors was observed with initiating the intervention. With implementation, a negative change in the slope of prescribing errors was observed (coefficient = -0.338; 95% CI: -0.612 to -0.064). The estimated RR of transcription errors was 0.74; 95% CI (0.59-0.92). The estimated RR of dosing calculation errors was 0.06; 95% CI (0.03-0.10). The estimated RR of chemotherapy frequency/duration errors was 0.51; 95% CI (0.42-0.62).
  
  
  CONCLUSIONS
  Implementing standardized chemotherapy-prescribing templates significantly reduced all types of prescribing errors and improved chemotherapy safety.
authors.affiliation: Department of Pharmaceutical Sciences, MCPHS University, 179 Longwood Ave, Boston, MA 02115, USA. khaled.elsaid@mcphs.edu.
authors.forename: K
authors.initials: K
authors.lastname: Elsaid
authors.forename: T
authors.initials: T
authors.lastname: Truong
authors.forename: M
authors.initials: M
authors.lastname: Monckeberg
authors.forename: H
authors.initials: H
authors.lastname: McCarthy
authors.forename: J
authors.initials: J
authors.lastname: Butera
authors.forename: C
authors.initials: C
authors.lastname: Collins
mesh_terms: D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D050316:Medical Order Entry Systems / Q000458:organization & administration / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012237:Rhode Island / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: CPOE; chemotherapy; interrupted time series; prescribing errors