Computerized prescriber order entry in the outpatient oncology setting: from evidence to meaningful use

BACKGROUND

Chemotherapy is an effective treatment in the fight against many cancers. Medication errors in oncology can be particularly serious given the narrow therapeutic window of antineoplastic drugs and their high toxicities. Computerized prescriber order entry (cpoe) has consistently been shown to reduce medication errors and adverse drug events in various settings, but its use in the oncology setting has not been well established. To gain a better understanding of the meaningful use of cpoe systems in the outpatient chemotherapy setting, we undertook a systematic review of systemic therapy cpoe.

METHODS

A province-wide expert panel consisting of clinical experts, health information professionals, and specialists in human factors design provided guidance in the development of the research questions, search terms, databases, and inclusion criteria. The systematic review was undertaken by a core team consisting of a medical oncologist, nurse, pharmacist, and methodologist. The medline, embase, cinahl, and compendex databases were searched for relevant evidence.

RESULTS

The database searches resulted in 5642 hits, of which 9 met the inclusion criteria and were retained. In the oncology setting, cpoe systems generally reduce chemotherapy medication errors; however, specific types of errors increase with the use of cpoe. These systems affect practice both positively and negatively with respect to time, workload, and productivity.

CONCLUSIONS

Despite the paucity of oncology-specific research, cpoe should be used in outpatient chemotherapy delivery to reduce chemotherapy-related medication errors. Adoption by clinicians will be enhanced by cpoe processes that complement current practice and workflow processes.

Compression bandaging improves mobility following total knee replacement in an enhanced recovery setting

The early functional outcome was assessed in 180 patients undergoing total knee replacement (TKR) using compression bandaging versus standard crepe bandaging. Patients with a compression bandage following TKR were significantly more likely to be discharged with a walking stick (p=0.002) and less likely to be discharged with a rollator frame (p=0.001). These patients demonstrated an improved range of knee flexion and ability to straight leg raise at discharge.

Physical inactivity and risk of hospitalisation for chronic obstructive pulmonary disease

The association between physical activity and risk of hospitalisation for chronic obstructive pulmonary disease (COPD) is not yet clear. We conducted a systematic review of the literature to fill this gap in knowledge. Eight electronic databases were searched using a selection of controlled vocabulary and keywords. The search resulted in more than 1000 initial hits, of which four met the inclusion criteria. For each identified study, relevant data were extracted and appraised. The results indicate that less physically active patients with COPD were more likely to be admitted to hospital. Consistent with a lower level of physical activity, the patients tended to have shorter walking times as well as spend fewer hours outdoors. In multivariate regression analysis, self-reported physical activity predicted hospitalisation in patients from the general population and re-hospitalisation in patients admitted for an acute exacerbation. The evidence for an association between physical activity and risk of hospitalisation for COPD is limited to a few prospective cohort studies. More research is needed to quantify the degree of physical activity associated with reduced risk of hospitalisation.