title: Prescription Errors with Chemotherapy: Quality Improvement through Standardized Order Templates.
abstract: BACKGROUND
  Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps.
  
  
  METHODS
  An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement.
  
  
  METHODS
  Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population.
  
  
  METHODS
  The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers.
  
  
  RESULTS
  Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement.
  
  
  CONCLUSIONS
  Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.
authors.affiliation: Department of Pharmacy Practice School of Pharmacy Lebanese American University Byblos, Lebanon E-mail : aline.saad@lau.edu.lb.
authors.forename: Aline
authors.initials: A
authors.lastname: Saad
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Der-Nigoghossian
authors.forename: Rachel
authors.initials: R
authors.lastname: Njeim
authors.forename: Riwa
authors.initials: R
authors.lastname: Sakr
authors.forename: Pascale
authors.initials: P
authors.lastname: Salameh
authors.forename: Marcel
authors.initials: M
authors.lastname: Massoud
mesh_terms: D000328:Adult; D016303:Clinical Pharmacy Information Systems; D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions / Q000592:standards*; D004360:Drug Therapy, Computer-Assisted / Q000592:standards*; D006236:Handwriting; D006801:Humans; D007861:Lebanon; D050316:Medical Order Entry Systems / Q000592:standards*; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D009369:Neoplasms / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011379:Prognosis; D058996:Quality Improvement; D012015:Reference Standards