Reduction in Chemotherapy Order Errors With Computerized Physician Order Entry
This is a review of Meisenberg, B. R., Wright, R. R., & Brady-Copertino, C. J. (2014). Reduction in chemotherapy order errors with computerized physician order entry. [1]
Abstract
It is very important to be able to correctly place chemotherapy orders in order to avoid mistakes; but this is difficult to accomplish as “Errors involving chemotherapy can occur at any stage of the process, including ordering, preparation, administration, and monitoring.” [1] . This article investigates three different methods (handwritten, pre-printed orders, and Computerized Physician Order Entry ) physicians may utilize to place orders and examines the various errors each may be subjected to.
Objective
The purpose of this article is to classify and quantify errors committed when physicians place orders through three different methods: “handwritten orders, preprinted orders, and computerized physician order entry (CPOE) embedded in the electronic health record.” [1]
Methods
Samples of orders placed between 2008 and 2012 were evaluated to obtain the number of mistakes committed, what type of error it was, and which ordering method was utilized to place the order. The resulting data was then examined and “compared using statistical methods.” [1]
Results
These three methods had the following number of overall errors: [1]
- 30.6% for handwritten orders
- 12.6% for pre-printed orders
- 2.2% for CPOE orders
The three methods had the following number of critical errors capable of risking harm to the patient: [1]
- 4.2% for handwritten orders
- 1.5% for pre-printed orders
- 0.1% for CPOE orders
Conclusions
The number of chemotherapy orders which contained errors decreased from handwritten order to preprinted orders, and decreased yet again for CPOE orders. It is important to note while CPOE had the best results in reducing the number of errors it was unable to completely eliminate errors from occurring; and the possibility exists for completely new issues to be introduced. [1]
Comments
This study did a good job to show CPOE, when implemented correctly, can serve to greatly reduce errors when placing orders; and provided a very important advice by pointing out errors were not eliminated altogether and advocating vigilance should be taken in regards to carefully testing new methodologies in order to avoid harming patients. [1]
Although CPOE generally showed a reduction of errors as compared to hand-written and pre-printed orders, six error types were also identified with its use:
- The CPOE system used lacked a safety mechanism to detect human error caused by unintended re-escalation of doses.
- Incorrect supportive care medications remained in the patient's profile after deleting a specific chemotherapy drug.
- Occurrence of overdosing when intended deletion of treatment days were not propagated.
- Occurrence of overdosing by mistyping as a result of alert fatigue.
- Inadvertent omission of drugs caused by failure of prescribers to correctly sign for regimens due to poor design of interface.
- Creating a mismatch between the expected order and the actual order when medication regimens were modified.
Nevertheless while reducing error, CPOE achieves other significant goals in patient care. The following are a few examples of the benefits of COPE:
- It reduces cost on both provider and patient side
- Facilitates care coordination
- Improves quality of care in general.
Related Article Review: Computerized prescriber order entry in the outpatient oncology setting: from evidence to meaningful use
