Document Type : Original Article
Authors
1 Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
2 department of Adult Hematology and Oncology, School of Medicine, Ayatollah Taleqhani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
BACKGROUND: Chemotherapy is a complex, multi‑disciplinary, and error‑prone process. Information
technology is being increasingly used in different health care settings with complex work procedures
such as cancer care to enhance the quality and safety of care. In this study, we aimed to develop
a computerized physician order entry (CPOE) for chemotherapy prescribing in patients with gastric
cancer and to evaluate the impact of CPOE on medication errors and order problems.
MATERIALS AND METHODS: A multi‑disciplinary team consisting of a chemotherapy council group
and system design and implementation team was formed for chemotherapy process evaluation,
requirement analysis, developing computer‑based protocols, and implementation of CPOE. A before
and after study was conducted to evaluate the impact of CPOE on the chemotherapy process and
medication errors and problem orders. To evaluate the level of end‑user satisfaction, an ISO Norm
9241/110 usability questionnaire was chosen for the evaluation.
RESULTS: Before the implementation of the CPOE system, 37 medication errors (46.25%) and
53 problem orders (66.25%) were recorded for 80 paper‑based chemotherapy prescriptions. After
implementation of the CPOE system, 7 (8.7%) medication errors and 6 (7.5%) problem orders were
recorded for 80 CPOE prescriptions. The implementation of CPOE reduced the medication error by
37.55% and the problematic order by 58.75%. The results for usability evaluation indicate that the
CPOE was within the first class of the ISONORM level rating; this shows that a CPOE is with very
high satisfaction and a very high functionality rate.
CONCLUSION: Developing a CPOE system significantly improved safety and quality of the
chemotherapy process in cancer care settings by reducing the medication error, deleting unnecessary
steps, improving communication and coordination between providers, and use of updated
evidence‑based medicine in direct chemotherapy orders. However, the CPOE system does not
prevent all medication errors and may cause new errors. These errors can be human‑related factors
or associated with the design and implementation of the systems.
Keywords
cancer: Epidemiology, risk factors, classification, genomic
characteristics and treatment strategies. Int J Mol Sci 2020;21:4012.
2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I,
Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates
of incidence and mortality worldwide for 36 cancers in 185
countries. CA Cancer J Clin 2021;71:209‑49.
3. Takahashi T, Saikawa Y, Kitagawa Y. Gastric cancer: Current
status of diagnosis and treatment. Cancers 2013;5:48‑63.
4. Ashokkumar R, Srinivasamurthy S, Kelly J, Howard S,
Parasuraman S, Uppugunduri Satyanarayana CR. Frequency
of chemotherapy medication errors: A systematic review.
J Pharmacol Pharmacother 2018;9:86‑91.
5. Ulas A, Silay K, Akinci S, Dede DS, Akinci MB, Sendur MAN,
et al. Medication errors in chemotherapy preparation and
administration: A survey conducted among oncology nurses in
Turkey. Asian Pac J Cancer Prev 2015;16:1699‑705.
6. Ranchon F, Salles G, Späth H‑M, Schwiertz V, Vantard N, Parat S,
et al. Chemotherapeutic errors in hospitalised cancer patients:
Attributable damage and extra costs. BMC Cancer 2011;11:478.
7. Weiss BD, Scott M, Demmel K, Kotagal UR, Perentesis JP,
Walsh KE. Significant and sustained reduction in chemotherapy
errors through improvement science. JOncol Pract 2017;13:e329‑36.
8. Lichtner V, Baysari M, Gates P, Dalla‐Pozza L, Westbrook JI.
Medication safety incidents in paediatric oncology after electronic
medication management system implementation. Eur J Cancer
Care (Engl) 2019;28:e13152.
9. Neville H, Broadfield L, Harding C, Heukshorst S, Sweetapple J,
Rolle M. Chemotherapy order entry by a clinical support
pharmacy technician in an outpatient medical day unit. Can J
Hosp Pharm 2016;69:202‑8.
10. KaloK, KariusD, Bena JF, MorrisonSL, Albert NM. Chemotherapy
safety: Reducing errors with a nurse‑led time‑out process. Clin J
Oncol Nurs 2019;23:197‑202.
11. Aita M, Belvedere O, De Carlo E, Deroma L, De Pauli F, Gurrieri L,
et al. Chemotherapy prescribing errors: An observational study on
the role of information technology and computerized physician
order entry systems. BMC Health Serv Res 2013;13:522.
12. Saad A, Der‑Nigoghossian CA, Njeim R, Sakr R, Salameh P,
Massoud M. Prescription errors with chemotherapy: Quality
improvement through standardized order templates. Asian Pac
J Cancer Prev 2016;17:2329‑36.
13. Weant KA, Bailey AM, Baker SN. Strategies for reducing
medication errors in the emergency department. Open Access
Emerg Med 2014;6:45‑55.
14. Yarmohammadian MH, Mohammadinia L, Tavakoli N, Ghalriz P,
Haghshenas A. Recognition of medical errors’ reporting system
dimensions in educational hospitals. J Educ Health Promot
2014;3:76.
15. Saghaeiannejad‑Isfahani S, MirzaeianR, Jannesari H, EhteshamiA,
Feizi A, Raeisi A. Evaluation of pharmacy information system in
teaching, private and social services Hospitals in 2011. J Edu
Health Promot 2014;3:39.
16. Aidah S, Gillani SW, Alderazi A, Abdulazeez F. Medication
error trends in Middle Eastern countries: A systematic review
on healthcare services. J Educ Health Promot 2021;10:227.
17. Rinke ML, Bundy DG, Velasquez CA, Rao S, Zerhouni Y,
Lobner K, et al. Interventions to reduce pediatric medication
errors: A systematic review. Pediatrics 2014;134:338‑60.
18. Vosters O, Jaadar Y, Vidts L‑A, Demols A, Lorent S, Liévin V,
et al. Implementation of a new health information technology for
the management of cancer chemotherapies. Eur J Hosp Pharm
2018;25:281‑5.
19. Chung C, Patel S, Lee R, Fu L, Reilly S, Ho T, et al. Implementation
of an integrated computerized prescriber order‑entry system for
chemotherapy in a multisite safety‑net health system. Bull Am
Soc Hos Pharm 2018;75:398‑406.
20. Carrington C, Stone L, Koczwara B, Searle C, Siderov J,
Stevenson B, et al. The Clinical oncological society of
Australia (COSA) guidelines for the safe prescribing, dispensing
and administration of cancer chemotherapy. Asia Pac J Clin Oncol
2010;6:220‑37.
21. Goldspiel B, Hoffman JM, Griffith NL, Goodin S, DeChristoforo R,
Montello CM, et al. ASHP guidelines on preventing medication
errors with chemotherapy and biotherapy. Am J Health Syst
Pharm 2015;72:e6‑35.
22. Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR,
LeFebvre KB, et al. 2013 updated American society of clinical
oncology/oncology nursing society chemotherapy administration
safety standards including standards for the safe administration
and management of oral chemotherapy. J Oncol Pract
2013;9 (2 Suppl):5s‑13s.
23. Jacobson JO, Polovich M, Gilmore TR, Schulmeister L, Esper P,
Lefebvre KB, et al. Revisions to the 2009 American society of
clinical oncology/oncology nursing society chemotherapy
administration safety standards: Expanding the scope to include
inpatient settings. Oncol Nurs Forum 2012;39:31‑8.
24. NeussMN, GilmoreTR, BeldersonKM, BillettAL, Conti‑KalchikT,
Harvey BE, et al. 2016 updated American society of clinical
oncology/oncology nursing society chemotherapy administration
safety standards, including standards for pediatric oncology.
J Oncol Pract 2016;12:1262‑71.
25. Meisenberg BR, Wright RR, Brady‑Copertino CJ. Reduction in
chemotherapy order errors with computerized physician order
entry. J Oncol Pract 2014;10:e5‑9.
26. Afrash MR, Rabiei R, Hosseini A, Salari S, Sepehri M. Impact
of computerized provider order entry on chemotherapy
medication errors: A systematic review. Int J Cancer Manag 2022;15:e120300.
27. Aziz MT, Ur‑Rehman T, Qureshi S, Bukhari NI. Reduction in
chemotherapy order errors with computerised physician order
entry and clinical decision support systems. Health Inf Manag
2015;44:13‑22.
28. Voeffray M, Pannatier A, Stupp R, Fucina N, Leyvraz S,
Wasserfallen J‑B. Effect of computerisation on the quality and
safety of chemotherapy prescription. Qual Saf Health Care
2006;15:418‑21.
29. Afrash MR, Hosseini A, Rabiei R, Salari S, Sepehri MM, Kianersi S.
Design and implementation of a guideline‑based workflow
software system for improving the chemotherapy process. Shiraz
E‑Medical Journal 2022;23(5):e119010.
30. Harshberger CA, Harper AJ, Carro GW, Spath WE, Hui WC,
Lawton JM, et al. Outcomes of computerized physician order
entry in an electronic health record after implementation in an
outpatient oncology setting. J Oncol Pract 2011;7:233‑7.
31. Pirnejad H, Gao C, Reddingius R, Rijneveld A, Bal R. Improving
chemotherapy processes with a protocol‑based information
system: A pre and post‑implementation study. Int J Med Inform
2013;82:220‑9.
32. Valencia FS, RuizR, Neciosup SP, Mas LA, Aliaga KM, Huaman F,
et al. Implementation of computerized physician order entry for
chemotherapy: A latin American experience. JCO Clin Cancer
Inform 2018;2:1‑12.
33. Wang L, Li Y, Lou Y, Zhang G, Chen J, Wang Y, et al.
Chemotherapy‑related risk management toward safe
administration of medications: Apply failure mode and effects
analysis to reduce the incidence of chemotherapy errors. Pak J
Pharm Sci 2017;30:713‑20.
34. Small MD, Pharm B, Barrett A, Price GM. The impact of
computerized prescribing on error rate in a department of
oncology/hematology. J Oncol Pharm Pract 2008;14:181‑7.
35. Martin D, Kaemingk D, Frieze D, Hendrie P, Payne T. Safe
implementation of computerized provider order entry for adult
oncology. Appl Clin Inform 2015;6:638‑49.
)