Reduction in Chemotherapy Order Errors With Computerized Physician Order Entry and Clinical Decision Support Systems

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This is a review of the paper by Aziz, et al. [1]


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. Method: 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. Results and Conclusion: 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.


The authors report on the effectiveness of a chemotherapy CPOE, as it was implemented in the chemotherapy ward of a tertiary hospital in Pakistan.


The paper (P-CO) and computerized (C-CO) order systems were evaluated 6 months after the C-CO went live. For patients with adult chemotherapy orders, metrics evaluated included tracking medication errors, dispensing time, and a categorical evaluation of cost. The C-CO was also evaluated by questionnaire for usability.


Medication errors were sharply reduced with the C-CO, from 134/5514 to 10/3765. The pharmacy intervention rate was lower on C-CO, and the acceptance of pharmacy intervention was higher. Dispensing times were faster on C-CO.

CPOE of chemotherapy order (C-CO) with a Clinical Decision Support System significantly reduces the frequency of medication errors, promotes rational prescribing and leads to a considerably shorter time needed to deliver services to patients.


The C-CO decreased the incidence of medication errors in ordering adult chemotherapeutic agents. Dispensing times were slightly faster. These findings were in line with the expected result of CPOE/CDSS pharmacy implementation.


The study confirms that the most concrete and measurable benefit of CPOE deployment is likely to be a drop in ADE. The decrease in dispensing cost was attributed to better inventory control with electronic ordering. The cost analysis was weak, and the cost of the system was not factored in in this analysis. I suspect that clear data showing an overall cost benefit would be more challenging to tease out.


  1. Aziz, M. T., Ur-Rehman, T., Qureshi, S., & Bukhari, N. I. (2015). Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems. The HIM Journal, 44(3), 13–22.