title: Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems.
abstract: BACKGROUND
  Medication errors in chemotherapy are frequent and lead to patient morbidity and mortality, as well as increased rates of re-admission and length of stay, and considerable extra costs. Objective: This study investigated the proposition that computerised chemotherapy ordering reduces the incidence and severity of chemotherapy protocol errors.
  
  
  METHODS
  A computerised physician order entry of chemotherapy order (C-CO) with clinical decision support system was developed in-house, including standardised chemotherapy protocol definitions, automation of pharmacy distribution, clinical checks, labeling and invoicing. A prospective study was then conducted in a C-CO versus paper based chemotherapy order (P-CO) in a 30-bed chemotherapy bay of a tertiary hospital. Both C-CO and P-CO orders, including pharmacoeconomic analysis and the severity of medication errors, were checked and validated by a clinical pharmacist. A group analysis and field trial were also conducted to assess clarity, feasibility and decision making.
  
  
  CONCLUSIONS
  The C-CO was very usable in terms of its clarity and feasibility. The incidence of medication errors was significantly lower in the C-CO compared with the P-CO (10/3765 [0.26%] versus 134/5514 [2.4%]). There was also a reduction in dispensing time of chemotherapy protocols in the C-CO. The chemotherapy computerisation with clinical decision support system resulted in a significant decrease in the occurrence and severity of medication errors, improvements in chemotherapy dispensing and administration times, and reduction of chemotherapy cost.
authors.affiliation: Department of Pharmacy Quaid-i-Azam University, Islamabad, Pakistan.
authors.forename: Muhammad Tahir
authors.initials: MT
authors.lastname: Aziz
authors.affiliation: Department of Pharmacy Quaid-i-Azam University, Islamabad, Pakistan.
authors.forename: Tofeeq
authors.initials: T
authors.lastname: Ur-Rehman
authors.affiliation: Department of Biochemistry FMH College of Medicine and Dentistry, Lahore, Pakistan.
authors.forename: Sadia
authors.initials: S
authors.lastname: Qureshi
authors.affiliation: University College of Pharmacy University of the Punjab, Lahore, Pakistan.
authors.forename: Nadeem Irfan
authors.initials: NI
authors.lastname: Bukhari
mesh_terms: D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions / Q000592:standards*; D004358:Drug Therapy / Q000592:standards*; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors; D010820:Physicians