Document Type : Original Article


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


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.


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