Chemotherapy prescribing errors: an observational study on the role of information technology and computerized physician order entry systems

• Published in: BMC health services research Vol. 13; no. 1; p. 522
• Main Authors: Aita, Marianna, Belvedere, Ornella, De Carlo, Elisa, Deroma, Laura, De Pauli, Federica, Gurrieri, Lorena, Denaro, Angela, Zanier, Loris, Fasola, Gianpiero
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.12.2013; BioMed Central
• Subjects: Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Cancer; Cancer therapies; Chemotherapy; Computerized physician order entry; Cytotoxicity; Drug dosages; Drug interactions; Drug stores; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - prevention & control; Electronic Prescribing - statistics & numerical data; Female; Health aspects; Hospitals; Humans; Information systems; Information technology; Length of stay; Male; Medical errors; Medical Order Entry Systems - statistics & numerical data; Medical records; Medication errors; Medication Errors - prevention & control; Medication Errors - statistics & numerical data; Middle Aged; Observational studies; Oncology; Order entry; Patients; Prescription writing; Prescriptions; Retrospective Studies; Italy
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-13-522

Chemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used. Up to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale. Eight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome. Chemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.