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Smith E, Fox A, Willmers G, Wright D, Stuart B. Impact of implementing the aseptic compounding management system, Medcura, on internal error rates within an oncology pharmacy aseptic unit: a mixed methods evaluation. Eur J Hosp Pharm 2024; 31:220-226. [PMID: 36241376 DOI: 10.1136/ejhpharm-2022-003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND As cancer survivorship improves, pressure on oncology services to provide safe, timely treatments increases. Traditional manual compounding processes are error prone, putting patients at risk. Additionally, errors have a detrimental impact on service delivery and staff morale. Information technology is increasingly utilised to improve safety and service delivery of systemic anti-cancer therapy (SACT). The compounding process control system, Medcura, was developed to manage the end-to-end process and reduce transcription and calculation errors. OBJECTIVES To evaluate the impact of implementing Medcura on internal errors and staff perceptions of errors. METHOD An aseptic process control system, Medcura, was implemented in a busy pharmacy chemotherapy production unit. Internal error and severity data were collected and analysed for 14 months before and during implementation, and 24 months after implementation. In addition, one-to-one semi-structured interviews were carried out with pharmacy staff, pre- and post-implementation. Interviews were transcribed and thematically analysed. RESULTS Error rates decreased after implementation from 2.9% to 2.1%. The types of error detected also changed with a decrease in worksheet and labelling errors, and an increase in assembly errors. The severity of the errors, as a percentage of total errors made, also decreased after implementation. Staff were predominantly positive about Medcura; it reduced the number of errors, eased the preparation of worksheets and labels, reduced pressure and work-related stress, and improved job satisfaction. CONCLUSIONS Implementing Medcura has resulted in a reduction in both error rate and severity. Specifically, errors related to label and worksheet generation have seen the largest reduction. Staff have viewed these changes positively and report reduced levels of work-related stress. Further development and roll-out will improve patient safety and staff morale.
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Affiliation(s)
- Emily Smith
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andy Fox
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Graeme Willmers
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Deborah Wright
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beth Stuart
- University of Southampton Faculty of Medicine, Southampton, Southampton, UK
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Parzianello A, Fornasier G, Kiren V, Pigato F, Orzetti S, Zamagni G, Arbo A, Baldo P, Rossi P, Rabusin M, Mascarin M, Trojniak MP. Improving Drug Safety in Pediatric and Young Adult Patients with Hemato-Oncological Diseases: A Prospective Study of Active Pharmacovigilance. Pharmaceuticals (Basel) 2024; 17:106. [PMID: 38256939 PMCID: PMC10821342 DOI: 10.3390/ph17010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The acquisition of relevant pediatric clinical safety data is essential to ensure tolerable drug therapies. Comparing the real number of Adverse Drug Reaction (ADR) reports in clinical practice with the literature, the idea of ADR underreporting emerges. An active pharmacovigilance observational prospective study was conducted to assess the safety of oncology pharmacological prescriptions in patients aged 0-24 years at Institute for Maternal and Child Health IRCCS Burlo Garofolo in Trieste and IRCCS CRO National Cancer Institute in Aviano (Italy) between January 2021 and October 2023. Prescriptions and ADRs were evaluated by a multidisciplinary team. A total of 1218 prescriptions for 38 patients were analyzed, and 190 ADRs of grade 3-5 were collected. As compared to historical data, we registered a significant increase (p < 0.001) in the number of ADRs. The risk of ADR was 3.4 times higher in the case of off-label prescriptions compared to on-label ones (OR 3.4; [1.47; 7.89]; p-value = 0.004). The risks of error and near-miss were reported for 6.3% and 18.2% of total prescriptions, respectively. Of the total of 133 interactions, 47 (35.3%) resulted in ADRs. This study shows the importance of pro-active pharmacovigilance to efficiently highlight ADRs, and the fundamental role of multidisciplinary teams (oncologist, pharmacist, pharmacologist, pediatrician, nurse) in improving patients' safety during therapy.
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Affiliation(s)
- Anna Parzianello
- Department of Medicine, Surgery and Health Sciences, Postgraduate School of Clinical Pharmacology and Toxicology, University of Trieste, 34127 Trieste, Italy;
| | - Giulia Fornasier
- Regional Agency for Health Coordination of Friuli Venezia Giulia (ARCS), 33100 Udine, Italy;
| | - Valentina Kiren
- Pediatric Hemato-Oncology Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.K.); (M.R.)
| | - Federico Pigato
- Pharmacy Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (F.P.); (A.A.)
| | - Sabrina Orzetti
- Pharmacy Unit, IRCCS CRO National Cancer Institute, 33081 Aviano, Italy; (S.O.); (P.B.)
| | - Giulia Zamagni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Anna Arbo
- Pharmacy Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (F.P.); (A.A.)
| | - Paolo Baldo
- Pharmacy Unit, IRCCS CRO National Cancer Institute, 33081 Aviano, Italy; (S.O.); (P.B.)
| | - Paola Rossi
- Central Directorate for Health, Social Policies and Disability—Friuli Venezia Giulia Region, Regional Center for Pharmacovigilance, 34121 Trieste, Italy;
| | - Marco Rabusin
- Pediatric Hemato-Oncology Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (V.K.); (M.R.)
| | - Maurizio Mascarin
- Integrated Oncology for Adolescents and Young Adults and Pediatric Radiotherapy Unit, IRCCS CRO National Cancer Institute, 33081 Aviano, Italy;
| | - Marta Paulina Trojniak
- Pharmacy Unit, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (F.P.); (A.A.)
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Climent-Ballester S, García-Salom P, Sanz-Valero J. Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature. Front Public Health 2023; 11:1233264. [PMID: 37711235 PMCID: PMC10498460 DOI: 10.3389/fpubh.2023.1233264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs). Methods The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital." Results A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations. Conclusion Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.
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Affiliation(s)
- Seira Climent-Ballester
- Pharmacy Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pedro García-Salom
- Pharmacy Service, Dr. Balmis General University Hospital, Alicante, Spain
| | - Javier Sanz-Valero
- National School of Occupational Medicine, Carlos III Health Institute, Madrid, Spain
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Dupre M, Escalup L, Blondeel-Gomes S, Vaflard P, Desmaris R, Cottu P, Acramel A. Errors in prescribing injectable anticancer drugs: benefits of a pharmaceutical long-term monitoring to improve patient safety in a European comprehensive cancer centre. Eur J Hosp Pharm 2023:ejhpharm-2023-003680. [PMID: 37188505 DOI: 10.1136/ejhpharm-2023-003680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES We aimed to assess the impact of pharmacist interventions on injectable chemotherapy prescription and the safety of early prescription practice in an adult daily care unit. METHODS Prescription errors were recorded before and after implementing corrective measures. Errors identified from the pre-intervention period (i) were analysed to identify areas for improvement. During the post-intervention period (ii) we compared the errors in anticipated prescription (AP) with those in real-time prescriptions (RTP). We performed Chi-square statistical tests (α=0.05). RESULTS Before implementing corrective measures (i), 377 errors were recorded (ie, 3.02% of prescriptions). After the implementation of corrective measures (ii), there was a significant decrease in errors, with 94 errors recorded (ie, 1.20% of prescriptions). The error rate in AP and RTP groups was 1.34% and 1.02%, respectively, without a significant difference between the two groups. CONCLUSIONS This study highlights the importance of prescription review, as well as collaboration between pharmacists and physicians, in reducing prescription errors, whether these prescriptions were anticipated or not.
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Affiliation(s)
- Mathilde Dupre
- Pharmacy, Institut Curie, PSL Research University, Paris, France
| | - Laurence Escalup
- Pharmacy, Institut Curie, PSL Research University, Paris, France
| | | | - Pauline Vaflard
- Oncologie Médicale, Institut Curie, PSL Research University, Paris, France
| | - Romain Desmaris
- Pharmacy, Institut Curie, PSL Research University, Paris, France
| | - Paul Cottu
- Oncologie Médicale, Institut Curie, PSL Research University, Paris, France
| | - Alexandre Acramel
- Pharmacy, Institut Curie, PSL Research University, Paris, France
- CiTCoM, UMR8038 CNRS, U1268 Inserm, Université Paris Cité, Paris, France
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O'Connor S, Matthews H, Hornby C. VicTAG chemotherapy audit toolkit: Improving chemotherapy quality and safety. J Oncol Pharm Pract 2023; 29:416-421. [PMID: 36567674 DOI: 10.1177/10781552221148118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Off-protocol prescribing of systemic anti-cancer therapy (SACT) can lead to concerns about effectiveness of patient care. To identify variations in practice, a toolkit was developed for health services to address patient safety and the risk of sub-optimal outcomes for patients. DATA SOURCES Following significant incidents with SACT in South Australia and New South Wales, the Department of Health and Human Services, Victoria (the department) conducted an assessment of Victorian public health services to understand current practice regarding SACT protocol governance. A literature review examining SACT auditing was also undertaken to guide improvements. A department supported Chemotherapy Audit Toolkit (CAT) was created for implementation at public hospitals in Victoria. A post-implementation survey was done on uptake and issue identification. DATA SUMMARY An initial assessment showed that 27% of Victorian public health services were undertaking retrospective review of SACT dosing, which was targeted for improvement. The literature review identified little guidance, however an audit of current sector practices found several audit methodologies. A process that involved audits by health services assessing their own practice was adopted. The toolkit was developed and piloted with health services. A post-implementation survey showed that 20% of services were using the toolkit, 35% were implementing the toolkit and 45% did not use the toolkit. CONCLUSIONS The VicTAG CAT has been adopted by more than half of Victorian public health services and is being used to influence prescribing. Implementation of the toolkit has been affected by resource reallocation due to the COVID-19 pandemic. The CAT is available online.
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Affiliation(s)
- Shaun O'Connor
- Department of Health, Commissioning and System Improvement, Melbourne, Australia.,60078St Vincent's Public Hospital, Melbourne, Australia
| | - Helen Matthews
- Victorian Therapeutic Advisory Group, Melbourne, Australia
| | - Colin Hornby
- Department of Health, Commissioning and System Improvement, Melbourne, Australia
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Afrash MR, Kianersi S, Bahadori M. Design, implementation, and evaluation of a CPOE system in a cancer care setting: A case study on the gastric cancer patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:58. [PMID: 37113421 PMCID: PMC10127491 DOI: 10.4103/jehp.jehp_263_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/09/2022] [Indexed: 06/19/2023]
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.
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Affiliation(s)
- Mohammad Reza Afrash
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shirin Kianersi
- Department of Adult Hematology and Oncology, School of Medicine, Ayatollah Taleqhani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Impact of Computerized Provider Order Entry on Chemotherapy Medication Errors: A Systematic Review. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-120300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Chemotherapy errors are considered the second most common cause of fatal medication errors (ME). Currently, computerized provider order entry (CPOE) is increasingly used to prevent or decrease ME and improve the safety of the medication process. Objectives: This study was conducted to systematically review the impacts of CPOE on the incidence of chemotherapy ME, the severity of errors, and adverse drug events (ADEs) in cancer care units. Data Sources: The literature search was conducted, using 5 databases of PubMed, EMBASE, Scopus, Web of Science, and ScienceDirect between 2000 and 2020. Search terms included keywords and MESH terms related to CPOE, ME, chemotherapy, and cancer care unit. Study Selection: Articles were included in this research if they investigated the CPOE system, reported ME, and were carried out in the oncology department. Non-English papers, duplications, review studies, and conference papers were excluded. Data Extraction: The selected papers were read repeatedly and related papers were extracted. All eligible articles were qualitatively evaluated with a tool provided by Downs. The extracted information included the author’s name, year of publication, study location, type of study, study objectives, and main findings. Results: A total of 829 studies were retrieved. Fourteen articles met the inclusion criteria. Ten studies (71%) reported the impact of CPOE on chemotherapy ME in comparison with the paper-based ordering method. In 4 studies (29%), researchers developed a CPOE for the oncology department, and the system was, then, assessed concerning user experience, safety challenges as well as the effects of CPOE on ME. Nine articles (64%) reported the impact of the CPOE system on ME only in the prescribing phase, and 5 studies (36%) examined ME in all phases of the chemotherapy process. Five studies (36%) reported the impact of the CPOE system on ADEs and the severity of errors. Conclusions: Implementing CPOE is associated with a significant reduction in ME in all phases of the chemotherapy process. However, the CPOE does not prevent all MEs and may cause new errors. The rigorous analysis of the chemotherapy process and considering the designing principles could help develop the CPOE systems and minimize ME.
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Using failure mode and Effects Analysis to increase patient safety in cancer chemotherapy. Res Social Adm Pharm 2021; 18:3386-3393. [PMID: 34838476 DOI: 10.1016/j.sapharm.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/16/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Medication errors may occur during chemotherapy and can have fatal consequences. Healthcare Failure Mode and Effects Analysis (FMEA) is a method used to detect potential risks and prevent them. OBJECTIVE Aim of this study was to evaluate the medication process of intravenous tumor therapy in order to guarantee a high standard of patient safety. METHODS The main part of the study was performed at the University Hospital of Bonn, Germany. After assembling a multidisciplinary team, the individual steps of prescription, compounding, transport, and administration of chemotherapy were mapped in a flow diagram. The possible failures were identified and analyzed by calculating the risk priority numbers (RPNs). Finally, corrective actions were developed and after hypothetical implementation re-analyzed to measure their effects on the process. Subsequently, a shortened FMEA based on the catalogue failure modes developed in Bonn was carried out at the University Hospital of Cologne in order to evaluate its transferability to another hospital. RESULTS A total of 52 potential failure modes was identified in Bonn. Relating to the RPNs the most critically steps in the process were associated with the prescription, namely, incorrect information about individual parameters of the patient; non-standardized chemotherapy protocols; and problems related to supportive therapy. A significant risk reduction for most of the failure modes was assessed by implementing suitable corrective actions. The shortened FMEA in Cologne led to a different ranking of failure modes. CONCLUSION The implementation of this analysis has not only identified various safety gaps, but also shows how patient safety during chemotherapy can be enhanced. Moreover, it has sensitized the practitioners to failure modes potentially occurring in their work routine.
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Hung TKW, Tareen S, Ziyeh S, Kuperman GJ, Mao JJ, Pfister DG, Banerjee N. ChemoPalRx-A Mobile App That Enhances Chemotherapy Prescription Accuracy: A Cross-Sectional Study. JCO Clin Cancer Inform 2021; 5:897-903. [PMID: 34436930 PMCID: PMC9351840 DOI: 10.1200/cci.21.00053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE ChemoPalRx is a novel provider order entry mobile application for chemotherapy. This study aims to evaluate the accuracy of prescribing chemotherapy using ChemoPalRx versus handwritten orders at a safety-net hospital in Los Angeles. METHODS In a cross-sectional study from October 2019 to December 2019, we evaluated all outpatient chemotherapy orders for accuracy. Our primary predictor was type of prescription, dichotomized as handwritten or ChemoPalRx. Primary outcome was accuracy, dichotomized as accurate if no error was made on an order and as inaccurate if any error was made. Preplanned subgroup analyses were performed with covariates including provider experience, complexity of order, and day of order submission. We characterized error type and analyzed our data using univariate and multivariate logistic regression models. RESULTS Among 288 orders (78.5% handwritten; 21.5% ChemoPalRx), prescription accuracy was higher among ChemoPalRx (93.5%) compared with handwritten orders (81.4%; P = .012). In multivariate analysis, prescription accuracy remained superior for ChemoPalRx after adjusting for provider experience, complexity of order, and day of order submission (adjusted odds ratio, 1.82; P = .012). Compared with handwritten orders, ChemoPalRx orders had less missing or incorrect information (1.6% v 13.7%; P = .0016). ChemoPalRx orders were also more accurate on prescriptions that contained two or fewer medications (92.2% v 80.2%; P = .032), submitted on the highest patient-volume clinic day of the week (96.7% v 83.2%; P = .035), and generated by a senior fellow or an attending (97.3% v 76.9%; P = .001). CONCLUSION ChemoPalRx is associated with improved chemotherapy prescription accuracy over handwritten orders in the safety-net hospital setting and may serve as an alternative prescribing tool for oncology practices.
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Affiliation(s)
- Tony K. W. Hung
- Memorial Sloan Kettering Cancer Center, New York, NY,Tony K. W. Hung, MD, MBA, MSCR, Memorial Sloan Kettering Cancer Center, 1257 York Ave, New York, NY 10065; e-mail:
| | | | | | | | - Jun J. Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
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Zimmer K, Classen D, Cole J. Categorization of Medication Safety Errors in Ambulatory Electronic Health Records. PATIENT SAFETY 2021. [DOI: 10.33940/med/2021.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Preventable medication errors continue to affect the quality and consistency in the delivery of care. While numerous studies on medication safety have been performed in the inpatient setting, a review of ambulatory patient safety by the American Medical Association found that medication safety errors were the most frequent safety problems in the outpatient arena. The leading cause of ambulatory safety problems, adverse drug events (ADEs), are common, with estimates of more than 2 million ADEs each year in the ambulatory Medicare population alone, and these events are frequently preventable. We conducted an environmental scan that allowed us to create our own categorization schema of medication safety errors in electronic healthcare records (EHRs) found in the outpatient setting and observed which of these were additionally supported in the literature. This study combines data from the California Hospital Patient Safety Organization (CHPSO), with several key articles in the area of medication errors in the EHR era.
Method: To best utilize the various EHR ambulatory medication events submitted into CHPSO’s database, we chose to create a framework to bucket the near misses or adverse events (AEs) submitted to the database. This newly created categorization scheme was based on our own drafted categorization labels of events, after a high-level review, and from two leading articles on physician order entry. Additionally, we conducted a literature review of computerized provider order entry (CPOE) medication errors in the ambulatory setting. Within the newly created categorization scheme, we organized the articles based on issues addressed so we could see areas that were supported by the literature and what still needed to be researched.
Results: We initially screened the CHPSO database for ambulatory safety events and found 25,417 events. Based on those events, an initial review was completed, and 19,242 events were found in the “Medication or Other Substance” and “Other” categories, in which the EHR appeared to have been a potential contributing factor. This review identified a subset of 2,236 events that were then reviewed. One hundred events were randomly selected for further review to identify common categories. The most common categories in which errors occurred were orders in order sets and plans (n=12) and orders crossing or not crossing encounters (n=12), incorrect order placed on correct patient (n=10), orders missing (n=8), standing orders (n=8), manual data entry errors (n=6), and future orders (n=6).
Conclusion: There were several common themes seen in this analysis of ambulatory medication safety errors related to the EHR. Common among them were incorrect orders consisting of examples such as dose errors or ordering the wrong medication. The manual data entry errors consisted of height or weight being entered incorrectly or entering the wrong diagnostic codes. Lastly, different sources of medication safety information demonstrate a diversity of errors in ambulatory medication safety. This confirms the importance of considering more than one source when attempting to comprehensively describe ambulatory medication safety errors.
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Srinivasamurthy SK, Ashokkumar R, Kodidela S, Howard SC, Samer CF, Chakradhara Rao US. Impact of computerised physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review. Eur J Clin Pharmacol 2021; 77:1123-1131. [PMID: 33624119 PMCID: PMC8275496 DOI: 10.1007/s00228-021-03099-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/28/2021] [Indexed: 11/04/2022]
Abstract
Purpose Computerised prescriber (or physician) order entry (CPOE) implementation is one of the strategies to reduce medication errors. The extent to which CPOE influences the incidence of chemotherapy-related medication errors (CMEs) was not previously collated and systematically reviewed. Hence, this study was designed to collect, collate, and systematically review studies to evaluate the effect of CPOE on the incidence of CMEs. Methods A search was performed of four databases from 1 January 1995 until 1 August 2019. English-language studies evaluating the effect of CPOE on CMEs were selected as per inclusion and exclusion criteria. The total CMEs normalised to total prescriptions pre- and post-CPOE were extracted and collated to perform a meta-analysis using the ‘meta’ package in R. The systematic review was registered with PROSPERO CRD42018104220. Results The database search identified 1621 studies. After screening, 19 studies were selected for full-text review, of which 11 studies fulfilled the selection criteria. The meta-analysis of eight studies with a random effects model showed a risk ratio of 0.19 (95% confidence interval: 0.08–0.44) favouring CPOE (I2 = 99%). Conclusion The studies have shown consistent reduction in CMEs after CPOE implementation, except one study that showed an increase in CMEs. The random effects model in the meta-analysis of eight studies showed that CPOE implementation reduced CMEs by 81%. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-021-03099-9.
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Affiliation(s)
- Suresh Kumar Srinivasamurthy
- Department of Pharmacology, Ras Al Khaimah College of Medical Sciences, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Ramkumar Ashokkumar
- Cancer Services Business Informatics, Helen Diller Family Comprehensive Cancer, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Sunitha Kodidela
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Scott C Howard
- Department of Acute and Critical Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Caroline Flora Samer
- Division of Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Campbell M, Vu K, Pardhan A, Gallo-Hershberg D, Ku R, Redwood E, Simanovski V, Krzyzanowska MK. Toward a Common Goal: Improving Safety of Oral Chemotherapy Prescribing Practices at a Jurisdictional Level. JCO Oncol Pract 2020; 16:e1036-e1044. [PMID: 32427539 DOI: 10.1200/jop.19.00797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Extending the safety agenda from parenteral to oral chemotherapy was identified as a provincial improvement priority in the 2014-2019 Cancer Care Ontario (CCO) Systemic Treatment Provincial Plan. Elimination of handwritten prescriptions for oral chemotherapy was one of the specific goals and led to a provincial quality improvement (QI) initiative involving systemic treatment facilities across 14 regional cancer programs. METHODS The initiative was centrally organized by CCO but locally implemented by the regional partners. CCO provided templates and tools, such as preprinted orders (PPOs), project charters, and an evaluation plan, and facilitated cross-jurisdictional knowledge sharing and exchange. Regions had flexibility in determining their local implementation strategies and were responsible for conducting chart audits to evaluate implementation success. Each participating hospital completed 3 audits-at baseline, immediately after implementation (audit 1), and 1 year later (audit 2)-using either a clinic-based or an outpatient pharmacy-based assessment. RESULTS Thirty-five facilities providing systemic treatment participated. At baseline, the provincial average for the use of computerized physician order entry (CPOE) or PPOs for prescribing oral chemotherapy was 71%. After implementation of the QI initiative, the provincial average for the use of CPOE or PPO increased to 91% at audit 1 and 95% at audit 2. CONCLUSION Although not all facilities met the goal of 100% CPOE or PPO compliance, the QI initiative led to improvement in safe prescribing practices for oral chemotherapy. A coordinated QI approach between a central decision maker and local partners can be an effective strategy to encourage high-quality cancer care and promote a culture of safety across a jurisdiction.
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Affiliation(s)
| | - Kathy Vu
- Cancer Care Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | | | - Daniela Gallo-Hershberg
- Cancer Care Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Ku
- Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Monika K Krzyzanowska
- Cancer Care Ontario, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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13
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Zecchini C, Vo TH, Chanoine S, Lepelley M, Laramas M, Lemoigne A, Allenet B, Federspiel I, Bedouch P. Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study. BMC Health Serv Res 2020; 20:113. [PMID: 32050957 PMCID: PMC7017539 DOI: 10.1186/s12913-020-4963-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit. Methods A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers’ perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.
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Affiliation(s)
- Céline Zecchini
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.
| | - Thi-Ha Vo
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,Pham Ngoc Thạch University of Medicine, Hochiminh, V-70000, Vietnam
| | - Sébastien Chanoine
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Marion Lepelley
- Centre Régional de Pharmacovigilance, F-38000, Grenoble, France
| | - Mathieu Laramas
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Cancer et maladies du sang, F-38000, Grenoble, France
| | - Aude Lemoigne
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France
| | - Benoît Allenet
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Isabelle Federspiel
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France
| | - Pierrick Bedouch
- Centre Hospitalo-Universitaire Grenoble Alpes, Pôle Pharmacie, F-38000, Grenoble, France.,CNRS, TIMC-IMAG, UMR5525, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
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14
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Tao L, Zhang C, Zeng L, Zhu S, Li N, Li W, Zhang H, Zhao Y, Zhan S, Ji H. Accuracy and Effects of Clinical Decision Support Systems Integrated With BMJ Best Practice-Aided Diagnosis: Interrupted Time Series Study. JMIR Med Inform 2020; 8:e16912. [PMID: 31958069 PMCID: PMC6997922 DOI: 10.2196/16912] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/02/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Clinical decision support systems (CDSS) are an integral component of health information technologies and can assist disease interpretation, diagnosis, treatment, and prognosis. However, the utility of CDSS in the clinic remains controversial. OBJECTIVE The aim is to assess the effects of CDSS integrated with British Medical Journal (BMJ) Best Practice-aided diagnosis in real-world research. METHODS This was a retrospective, longitudinal observational study using routinely collected clinical diagnosis data from electronic medical records. A total of 34,113 hospitalized patient records were successively selected from December 2016 to February 2019 in six clinical departments. The diagnostic accuracy of the CDSS was verified before its implementation. A self-controlled comparison was then applied to detect the effects of CDSS implementation. Multivariable logistic regression and single-group interrupted time series analysis were used to explore the effects of CDSS. The sensitivity analysis was conducted using the subgroup data from January 2018 to February 2019. RESULTS The total accuracy rates of the recommended diagnosis from CDSS were 75.46% in the first-rank diagnosis, 83.94% in the top-2 diagnosis, and 87.53% in the top-3 diagnosis in the data before CDSS implementation. Higher consistency was observed between admission and discharge diagnoses, shorter confirmed diagnosis times, and shorter hospitalization days after the CDSS implementation (all P<.001). Multivariable logistic regression analysis showed that the consistency rates after CDSS implementation (OR 1.078, 95% CI 1.015-1.144) and the proportion of hospitalization time 7 days or less (OR 1.688, 95% CI 1.592-1.789) both increased. The interrupted time series analysis showed that the consistency rates significantly increased by 6.722% (95% CI 2.433%-11.012%, P=.002) after CDSS implementation. The proportion of hospitalization time 7 days or less significantly increased by 7.837% (95% CI 1.798%-13.876%, P=.01). Similar results were obtained in the subgroup analysis. CONCLUSIONS The CDSS integrated with BMJ Best Practice improved the accuracy of clinicians' diagnoses. Shorter confirmed diagnosis times and hospitalization days were also found to be associated with CDSS implementation in retrospective real-world studies. These findings highlight the utility of artificial intelligence-based CDSS to improve diagnosis efficiency, but these results require confirmation in future randomized controlled trials.
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Affiliation(s)
- Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Chen Zhang
- Information Management and Big Data Center, Peking University Third Hospital, Beijing, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Shengrong Zhu
- Information Management and Big Data Center, Peking University Third Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Wei Li
- Information Management and Big Data Center, Peking University Third Hospital, Beijing, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yiming Zhao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Siyan Zhan
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hong Ji
- Information Management and Big Data Center, Peking University Third Hospital, Beijing, China
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15
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A chemotherapy privileging process for advanced practice providers at an academic medical center. J Oncol Pharm Pract 2020; 26:116-123. [DOI: 10.1177/1078155219846959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Nurse practitioners, physician assistants, and pharmacists are advanced practice providers who are highly trained and qualified healthcare professionals that can help support traditional demands on oncologists' increased time in direct patient care. The purpose of this study was to detail and assess the creation of a privileging process for this group of medical professionals within an academic medical center. Obtaining the designation of limited oncology practice provider (LOPP) gives the right to modify chemotherapy orders and to order supportive care medications. Methods An interdisciplinary team developed a comprehensive training process inclusive of required educational domains, knowledge goals, and educational activities to become an LOPP. In 2018, five years after the implementation of the privileging process, a survey was distributed to assess perceptions of the training process and integration of LOPPs within oncology practice. Results Most oncologists noted that working with LOPPs is beneficial to oncology practice (94%) and that they make modifying chemotherapy orders more efficient (87%). Greater than 82% of LOPPs also reported that their privileges streamline the chemotherapy process and make them feel valuable. Conclusion The creation of the LOPP designation is an effective way to integrate nurse practitioners, physician assistants, and pharmacists within oncology practice. The inclusion of a focused privileging process ensures the safety of cancer care provided and has created a streamlined process for chemotherapy modifications and supportive care.
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16
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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. [PMID: 31436876 PMCID: PMC7161912 DOI: 10.1111/ecc.13152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/22/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
Objective To explore medication safety issues related to use of an electronic medication management system (EMM) in paediatric oncology practice, through the analysis of patient safety incident reports. Methods We analysed 827 voluntarily reported incidents relating to oncology patients that occurred over an 18‐month period immediately following implementation of an EMM in a paediatric hospital in Australia. We identified medication‐related and EMM‐related incidents and carried out a content analysis to identify patterns. Results We found ~79% (n = 651) of incidents were medication‐related and, of these, ~45% (n = 294) were EMM‐related. Medication‐related incidents included issues with: prescribing; dispensing; administration; patient transfers; missing chemotherapy protocols and information on current stage of patient treatment; coordination of chemotherapy administration; handling or storing medications; children or families handling medications. EMM‐related incidents were classified into four groups: technical issues, issues with the user experience, unanticipated problems in EMM workflow, and missing safety features. Conclusions Incidents reflected difficulties with managing therapies rich in interdependencies. EMM, and especially its ‘automaticity’, contributed to these incidents. As EMM impacts on safety in such high‐risk settings, it is essential that users are aware of and attend to EMM automatic behaviours and are equipped to troubleshoot them.
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Affiliation(s)
- Valentina Lichtner
- Department of Practice and Policy, School of Pharmacy, UCL, London, UK.,Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
| | - Melissa Baysari
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia.,Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Peter Gates
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children Hospital at Westmead, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, AIHI, Macquarie University, Sydney, NSW, Australia
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17
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Salahuddin L, Ismail Z, Hashim UR, Ismail NH, Raja Ikram RR, Abdul Rahim F, Hassan NH. Healthcare practitioner behaviours that influence unsafe use of hospital information systems. Health Informatics J 2019; 26:420-434. [PMID: 30843460 DOI: 10.1177/1460458219833090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to investigate healthcare practitioner behaviour in adopting Health Information Systems which could affect patients' safety and quality of health. A qualitative study was conducted based on a semi-structured interview protocol on 31 medical doctors in three Malaysian government hospitals implementing the Total Hospital Information Systems. The period of study was between March and May 2015. A thematic qualitative analysis was performed on the resultant data to categorize them into relevant themes. Four themes emerged as healthcare practitioners' behaviours that influence the unsafe use of Hospital Information Systems. The themes include (1) carelessness, (2) workarounds, (3) noncompliance to procedure, and (4) copy and paste habit. By addressing these behaviours, the hospital management could further improve patient safety and the quality of patient care.
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18
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Weingart SN, Zhang L, Sweeney M, Hassett M. Chemotherapy medication errors. Lancet Oncol 2019; 19:e191-e199. [PMID: 29611527 DOI: 10.1016/s1470-2045(18)30094-9] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
Although chemotherapy is a well established treatment modality, chemotherapy errors represent a potentially serious risk of patient harm. We reviewed published research from 1980 to 2017 to understand the extent and nature of medication errors in cancer chemotherapy, and to identify effective interventions to help prevent mistakes. Chemotherapy errors occur at a rate of about one to four per 1000 orders, affect at least 1-3% of adult and paediatric oncology patients, and occur at all stages of the medication use process. Oral chemotherapy use is a particular area of growing risk. Our knowledge of chemotherapy errors is drawn primarily from single-institution studies at university hospitals and referral centres, with a particular focus on prescription orders and pharmacy practices. Although the heterogeneity of research methods and measures used in these studies limits our understanding of this issue, the rate of chemotherapy error-related injuries is generally lower than those seen in comparable studies of general medical patients. Although many interventions show promise in reducing chemotherapy errors, most have little empirical support. Additional research is needed to understand and to mitigate the risk of chemotherapy medication errors.
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Affiliation(s)
- Saul N Weingart
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
| | - Lulu Zhang
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Megan Sweeney
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Michael Hassett
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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19
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Chung C, Patel S, Lee R, Fu L, Reilly S, Ho T, Lionetti J, George MD, Taylor P. Implementation of an integrated computerized prescriber order-entry system for chemotherapy in a multisite safety-net health system. Am J Health Syst Pharm 2019. [PMID: 29523537 DOI: 10.2146/ajhp170251] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The development of a computerized prescriber order-entry (CPOE) system for chemotherapy in a multisite safety-net health system and the challenges to its successful implementation are described. SUMMARY Before CPOE for chemotherapy was first implemented and embedded in the electronic medical record system of Harris Health System (HHS), pharmacy personnel relied on regimen-specific preprinted order sets. However, due to differences in practice styles and workflow logistics, the paper orders across the 3 facilities were mostly site specific, with varying clinical content. Many of these order sets had not been approved by the oncology subcommittee. In addition, disparities in clinical knowledge and lack of communication contributed to inconsistencies in order set development. Led by medical directors from medical oncology departments at the 3 facilities, pharmacy administrators, and information technology representatives, HHS committed resources to supporting the adoption and use of a CPOE system for chemotherapy. Five practical lessons of broad applicability have been learned: engagement of interprofessional stakeholders, optimization of workflow before CPOE implementation, requirement of verification tool for CPOE, consolidation of protocols, and commitment to ongoing training and support. Evaluation of the CPOE system demonstrated a systemwide reduction in medication errors by 75% (p < 0.05). Satisfaction with the CPOE system varied among sites and was unchanged institutionwide 6 months after the CPOE implementation. CONCLUSION The development and implementation of CPOE for chemotherapy at a multisite safety-net health system created opportunities to optimize patient care and reduce variations through interprofessional collaborations. Initial evaluation suggested that CPOE reduced the medication-order error rate and improved user satisfaction in 1 of 3 facilities.
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Affiliation(s)
- Clement Chung
- Department of Pharmacy, University of Chicago Medicine, Chicago, IL
| | - Shital Patel
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Rosetta Lee
- Department of Pharmacy, Smith Clinic, Houston, TX
| | - Lily Fu
- Department of Pharmacy, Santa Rosa Memorial Hospital, Santa Rosa, CA
| | - Sean Reilly
- Department of Pharmacy, Parkview Regional Medical Center, Fort Wayne, IN
| | - Tuyet Ho
- Information Technology Department, Harris Health System, Houston, TX
| | - Jason Lionetti
- Information Technology Department, Harris Health System, Houston, TX
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20
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Rahimi R, Moghaddasi H, Rafsanjani KA, Bahoush G, Kazemi A. Effects of chemotherapy prescription clinical decision-support systems on the chemotherapy process: A systematic review. Int J Med Inform 2019; 122:20-26. [DOI: 10.1016/j.ijmedinf.2018.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 10/09/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
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21
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Daupin J, Perrin G, Lhermitte-Pastor C, Loustalot MC, Pernot S, Savoldelli V, Thibault C, Landi B, Sabatier B, Caudron E. Pharmaceutical interventions to improve safety of chemotherapy-treated cancer patients: A cross-sectional study. J Oncol Pharm Pract 2019; 25:1195-1203. [DOI: 10.1177/1078155219826344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Johanne Daupin
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
| | - Germain Perrin
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- INSERM UMR 1138, Equipe 22, Centre de recherche des Cordeliers, Paris, France
| | | | | | - Simon Pernot
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | - Virginie Savoldelli
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- Clinical Pharmacy Department, Faculty of Pharmacy, U-Psud University Paris-Saclay, Châtenay-Malabry, France
| | - Constance Thibault
- Department of Medical Oncology, Georges Pompidou European Hospital, Paris, France
| | - Bruno Landi
- Department of Gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France
| | - Brigitte Sabatier
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- INSERM UMR 1138, Equipe 22, Centre de recherche des Cordeliers, Paris, France
| | - Eric Caudron
- Pharmacy Department, Georges Pompidou European Hospital, Paris, France
- Lip(Sys)2 Laboratory of analytical chemistry, EA7357, U-Psud University Paris-Saclay, Châtenay-Malabry, France
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22
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Cotteret C, Marry S, Loeuillet R, Videau M, Cisternino S, Schlatter J. A virtual centralized cytotoxic preparation unit simulation to evaluate the pharmacy staff knowledge. J Oncol Pharm Pract 2019; 25:1187-1194. [PMID: 30626271 DOI: 10.1177/1078155218821426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The risk of medication errors related to drug preparation unit cannot be totally avoided because of human interference. The aim of this study is to investigate the background and knowledge of the pharmacy staff by replicating the cytotoxic preparation unit with potential errors. METHODS A 10-m2 room was provided to duplicate the centralized chemotherapy unit with three areas reproducing virtually the equipment preparation bench, the isolator, and the dispensing bench. The 14 situations selected by experts were integrated to each corresponded area. For each participant, a form was given and answers were analyzed by two independent experts. Statistical processing data were performed using GraphPad Prism® software. RESULTS A total of 19 professionals participated in error simulation workshop over a one-month period. The overall rate of correct responses was 58 ± 19%. In five situations, correct responses rate was lower than 50%: wrong drug batch related to the preparation sheet (40%), inappropriate sterilizing conditions (15%), the time on the preparation sheet provides an expired expiry date for melphalan preparation (45%), a maximum drug dose exceeded (25%), the dispensing form not corresponds to the preparation sheet and final product label (30%). The rate of correct responses was 45 ± 25% for professionals not specifically dedicated to chemotherapy preparation. The overall satisfaction workshop rate was 8.7 ± 1.0 out of 10. CONCLUSION This study showed the importance of training programs to sensitize personal staff to the risks of chemotherapy preparation and prevent errors.
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Affiliation(s)
- Camille Cotteret
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
| | - Stéphanie Marry
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
| | - Richard Loeuillet
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
| | - Margaux Videau
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
| | - Salvatore Cisternino
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France.,2 Inserm UMR-S 1144, Team "Blood-brain barrier in brain pathophysiology and therapy", Université Paris Descartes, Paris, France
| | - Joël Schlatter
- 1 Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades - APHP, Paris, France
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23
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Crespo A, Redwood E, Vu K, Kukreti V. Improving the Safety and Quality of Systemic Treatment Regimens in Computerized Prescriber Order Entry Systems. J Oncol Pract 2018; 14:e393-e402. [PMID: 29813012 DOI: 10.1200/jop.17.00064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Systemic treatment (ST) computerized prescriber order entry (CPOE) and preprinted orders (PPO) are proven to reduce errors. There is no known guidance in oncology to facilitate high-quality, accurate regimen development and review; hence, this was identified as a system-wide gap. This provincial initiative aimed to improve the quality of oncology regimens through a comprehensive review of systemic treatment (ST) regimens and the development of standards. METHODS A system-wide analysis of all active regimens (both CPOE and PPO) to ensure they were built as intended was conducted in 2015. Thirty-five hospitals (on behalf of 75 treatment facilities) were asked to report any unintentional discrepancies and details of the maintenance review process. Discrepancies were compiled, categorized, and analyzed for potential to cause harm. In addition, a multidisciplinary expert working group was formed to create best practice recommendations. RESULTS The review yielded a 94% response rate and took a total of 18 months to complete (70% completed within 9 months). The average number of regimens reviewed was 336 (range, 15 to 700; n = 9). Unintentional discrepancies were reported by nine hospitals (27%). A total of 369 discrepancies were reported (average, 55 per hospital), and 28 were deemed to have a moderate potential for harm. Only two hospitals (6%) had an established maintenance process; now, all have standard processes for review. Consensus-based recommendations for ST-CPOE and PPO regimen development and maintenance were developed. CONCLUSION The review identified unintentional discrepancies and, because of the potential for patient harm, corrective action has been taken. Identified discrepancies have been amended, and standard regimen development and maintenance review processes are now implemented system-wide to improve the quality and safety of systemic treatment delivery.
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Affiliation(s)
| | | | - Kathy Vu
- Cancer Care Ontario, Toronto, Ontario, Canada
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24
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Hamel C, Tortolano L, Bermudez E, Desmaris R, Klein S, Slimano F, Lemare F. Computerized pediatric oncology prescriptions review by pharmacist: A descriptive analysis and associated risk factors. Pediatr Blood Cancer 2018; 65. [PMID: 29251399 DOI: 10.1002/pbc.26897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Systematic prescription analyses by clinical pharmacists result in pharmacist interventions (PIs) to reduce prescription errors and improve medication safety. PIs are particularly critical in oncology, because antineoplastic drugs are highly toxic with low therapeutic indexes especially in a pediatric population. The aim of this study is to describe PIs in a pediatric oncology department and to identify potential risk factors associated with prescription errors. PROCEDURE We conducted a 20-month observational study in a pediatric oncology department concerning electronic prescription of injectable chemotherapies was conducted. PIs were analyzed for drug-related problems (DRPs), type of intervention, population characteristics, involved drugs, and the potential risk factors. RESULTS Clinical pharmacists made 90 PIs for 10,214 antineoplastic prescriptions for a rate of 88 PIs per 10,000 prescriptions. The majority of DRPs were dosage errors (61.8%), imputable to measurements (weight and/or height) in 47.4% or unreported dose reduction. The most common patient ages were in the range 1-10 years and the most common time for medical double checks was 2-9 pm. There were statistically more prescription errors in standardized protocols (P < 0.001). CONCLUSIONS Not surprisingly, PIs were predominantly to correct dose errors, half of which related to height and weight measurements that were not updated. No significant risk factors for errors were identified for errors except in the standardized status of prescription, which appears to be linked in part to our software that did not automatically reflect dose reduction from one course to the next. Medical double-checking followed by a clinical pharmacist's double check were effective in order to prevent prescription errors.
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Affiliation(s)
- Claire Hamel
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France
| | - Lionel Tortolano
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France.,EA401, IFR141, Faculty of Pharmacy, Paris-sud, University, Chatenay-Malabry, 92296, France.,Assistance Publique-Höpitaux de Paris, Groupe hospitalier Henri Mondor, Department of Pharmacy, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, F-94010, France
| | - Elisabeth Bermudez
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France
| | - Romain Desmaris
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France
| | - Sébastien Klein
- Department of Pediatric Oncology, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France
| | - Florian Slimano
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France.,MEDyC Research Unit, UMR CNRS/URCA no. 7369, Reims University, Reims, 51100, France.,Facuty of Pharmacy, Reims University, Reims, 51100, France
| | - François Lemare
- Department of Clinical Pharmacy, Gustave Roussy Cancer Campus, Villejuif Cedex, 94805, France.,Chair of Clinical Pharmacy, Faculty of Pharmacy of Paris, Sorbonne-Paris University, Paris, 75 270, France.,EA 7348 MOS, Ecole des Hautes Etudes en Santé Publique, Rennes, 35043, France
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Quaglini S, Sacchi L, Lanzola G, Viani N. Personalization and Patient Involvement in Decision Support Systems: Current Trends. Yearb Med Inform 2017; 10:106-18. [PMID: 26293857 DOI: 10.15265/iy-2015-015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. METHODS We considered papers published on scientific journals, by querying PubMed and Web of ScienceTM. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. RESULTS We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. CONCLUSIONS Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large.
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Affiliation(s)
- S Quaglini
- Silvana Quaglini, Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy, Tel: +39 0382 985058, Fax: +39 0382 985060, E-mail:
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Baldwin A, Rodriguez ES. Improving Patient Safety With Error Identification in Chemotherapy Orders by Verification Nurses. Clin J Oncol Nurs 2016; 20:59-65. [PMID: 26800407 DOI: 10.1188/16.cjon.59-65] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of medication errors associated with chemotherapy administration is not precisely known. Little evidence exists concerning the extent or nature of errors; however, some evidence demonstrates that errors are related to prescribing. This article demonstrates how the review of chemotherapy orders by a designated nurse known as a verification nurse (VN) at a National Cancer Institute-designated comprehensive cancer center helps to identify prescribing errors that may prevent chemotherapy administration mistakes and improve patient safety in outpatient infusion units. OBJECTIVES This article will describe the role of the VN and details of the verification process. METHODS To identify benefits of the VN role, a retrospective review and analysis of chemotherapy near-miss events from 2009-2014 was performed. FINDINGS A total of 4,282 events related to chemotherapy were entered into the Reporting to Improve Safety and Quality system. A majority of the events were categorized as near-miss events, or those that, because of chance, did not result in patient injury, and were identified at the point of prescribing.
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Abstract
PURPOSE Chemotherapy is a high-risk medication and is the second most common cause of fatal medication errors. The ordering process can be unsafe and inefficient, putting patients at risk for medication errors. The aim of this project was to decrease the number of chemotherapy order forms with at least one deviation by 50% within 5 months. METHODS A multidisciplinary team identified causes for variance in form completion, deficits in knowledge of ordering processes, and acceptance of incomplete orders by the staff. The Plan, Do, Study, Act improvement methodology evaluated the chemotherapy ordering process and found different types of deviations on order forms. Interventions consisted of educating physicians on entering complete information on orders, instituting same-day laboratory work on the day of the physician's visit, standardizing laboratory parameters, performing audits of the order forms manually, and educating nurses on not accepting orders with deviations. RESULTS All order forms were reviewed, and data were collected on different types of deviations. The following deviations were identified: laboratory test results were not being entered into the order form within 7 days, physicians were not providing their name and pager number, and the days of the chemotherapy cycle were missing from the order forms. Before the intervention, 70.1% of the chemotherapy order forms had at least one deviation. After 5 months of interventions, there was a reduction of 19% in the number of order forms with at least one deviation. Follow-up at 6 months and 1 year showed continuing reductions in the number of chemotherapy orders with at least one deviation. CONCLUSION Improvement was a result of collaboration between interdisciplinary departments. The original goal was surpassed as a result of educating physicians and staff and standardizing the ordering process. If the number of deviations in chemotherapy order forms is decreased, oncology patients will receive safe, efficient, and quality care.
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Sanchez Cuervo M, Rojo Sanchis A, Pueyo Lopez C, Gomez de Salazar Lopez de Silanes E, Gramage Caro T, Bermejo Vicedo T. The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation. J Clin Pharm Ther 2015; 40:550-554. [PMID: 26177870 DOI: 10.1111/jcpt.12305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/09/2015] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Computerized physician order entry (CPOE) systems reduce medical errors (MEs). Nevertheless, a CPOE system may also lead to new types of errors, especially when it is first implemented. The objectives of this study were to determine the impact of a CPOE on the number of MEs and to identify the types of MEs in prescriptions issued by the Haematology Department 5 years after the implementation of the CPOE system. METHODS We conducted a prospective analytical study on the implementation of a CPOE system at the Pharmacy Department of the Hospital Ramon y Cajal (Madrid, Spain). The study comprised three phases: a pre-implementation phase, an implementation phase conducted in the Haematology Department and a post-implementation phase, which was conducted 5 years after the implementation of the CPOE system. One hundred and fifty prescriptions per pre- and post-implementation phase were consecutively included in the study. A previously described classification scheme was used to detect and classify MEs. RESULTS AND DISCUSSION The implementation of a CPOE system was associated with a large reduction in MEs. One hundred and fourteen patients (pre-implementation phase) were compared to 82 patients (post-implementation phase). The total number of MEs per 100 patients decreased from 236·8 (95% CI: 212·1-261·3) to 10·9 (95% CI: 5·8-19·6), with an absolute risk reduction of 36·2 (95% CI: 32·6-39·9). The percentage of prescriptions with an ME decreased from 37·5% to 1·2% (P < 0.001). In the pre-implementation phase, the drugs most frequently associated with MEs were rituximab (35·9%), cyclophosphamide (13%) and methotrexate (7%). In the post-implementation phase, 44·4% of prescription errors involved methotrexate. Five years after the implementation of the CPOE system, the majority of MEs were eliminated, the number of remaining errors (quantity, concentration and ambiguous prescription errors) decreased, and no new types of ME were detected. WHAT IS NEW AND CONCLUSION The CPOE system almost completely eliminated MEs with antineoplastic drugs in the Haematology Department. No new types of MEs were observed once physicians had become accustomed to using the system. However, some MEs were not eliminated. Constant diligence is needed to analyse and evaluate MEs associated with the CPOE system and their causes, such that the limitations of CPOE can be identified and overcome and the medication-use process associated with antineoplastic agents improved.
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Affiliation(s)
| | - A Rojo Sanchis
- Department of Pharmacy, Ramon y Cajal Hospital, Madrid, Spain
| | - C Pueyo Lopez
- Department of Pharmacy, Ramon y Cajal Hospital, Madrid, Spain
| | | | - T Gramage Caro
- Department of Pharmacy, Ramon y Cajal Hospital, Madrid, Spain
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McElroy LM, Khorzad R, Nannicelli AP, Brown AR, Ladner DP, Holl JL. Failure mode and effects analysis: a comparison of two common risk prioritisation methods. BMJ Qual Saf 2015; 25:329-36. [PMID: 26170336 DOI: 10.1136/bmjqs-2015-004130] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/21/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Failure mode and effects analysis (FMEA) is a method of risk assessment increasingly used in healthcare over the past decade. The traditional method, however, can require substantial time and training resources. The goal of this study is to compare a simplified scoring method with the traditional scoring method to determine the degree of congruence in identifying high-risk failures. METHODS An FMEA of the operating room (OR) to intensive care unit (ICU) handoff was conducted. Failures were scored and ranked using both the traditional risk priority number (RPN) and criticality-based method, and a simplified method, which designates failures as 'high', 'medium' or 'low' risk. The degree of congruence was determined by first identifying those failures determined to be critical by the traditional method (RPN≥300), and then calculating the per cent congruence with those failures designated critical by the simplified methods (high risk). RESULTS In total, 79 process failures among 37 individual steps in the OR to ICU handoff process were identified. The traditional method yielded Criticality Indices (CIs) ranging from 18 to 72 and RPNs ranging from 80 to 504. The simplified method ranked 11 failures as 'low risk', 30 as medium risk and 22 as high risk. The traditional method yielded 24 failures with an RPN ≥300, of which 22 were identified as high risk by the simplified method (92% agreement). The top 20% of CI (≥60) included 12 failures, of which six were designated as high risk by the simplified method (50% agreement). CONCLUSIONS These results suggest that the simplified method of scoring and ranking failures identified by an FMEA can be a useful tool for healthcare organisations with limited access to FMEA expertise. However, the simplified method does not result in the same degree of discrimination in the ranking of failures offered by the traditional method.
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Affiliation(s)
- Lisa M McElroy
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA Northwestern University Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
| | - Rebeca Khorzad
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA Northwestern University Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
| | - Anna P Nannicelli
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexandra R Brown
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniela P Ladner
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA Northwestern University Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
| | - Jane L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA Northwestern University Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
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McElroy LM, Collins KM, Koller FL, Khorzad R, Abecassis MM, Holl JL, Ladner DP. Operating room to intensive care unit handoffs and the risks of patient harm. Surgery 2015; 158:588-94. [PMID: 26067459 DOI: 10.1016/j.surg.2015.03.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The goal of this study was to assess systems and processes involved in the operating room (OR) to intensive care unit (ICU) handoff in an attempt to understand the criticality of specific steps of the handoff. METHODS We performed a failure modes, effects, and criticality analysis (FMECA) of the OR to ICU handoff of deceased donor liver transplant recipients using in-person observations and descriptions of the handoff process from a multidisciplinary group of clinicians. For each step in the process, failures were identified along with frequency of occurrence, causes, potential effects and safeguards. A Risk Priority Number (RPN) was calculated for each failure (frequency × potential effect × safeguard; range 1-least risk to 1,000-most risk). RESULTS Using FMECA, we identified 37 individual steps in the OR to ICU handoff process. In total, 81 process failures were identified, 22 of which were determined to be critical and 36 of which relied on weak safeguards such as informal human verification. Process failures with the greatest risk of harm were lack of preliminary OR to ICU communication (RPN 504), team member absence during handoff communication (RPN 480), and transport equipment malfunction (Risk Priority Number 448). CONCLUSION Based on the analysis, recommendations were made to reduce potential for patient harm during OR to ICU handoffs. These included automated transfer of OR data to ICU clinicians, enhanced ICU team member notification processes and revision of the postoperative order sets. The FMECA revealed steps in the OR to ICU handoff that are high risk for patient harm and are currently being targeted for process improvement.
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Affiliation(s)
- Lisa M McElroy
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Kelly M Collins
- Section of Transplantation, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Felicitas L Koller
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rebeca Khorzad
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael M Abecassis
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jane L Holl
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniela P Ladner
- Center for Healthcare Studies and Center for Education in Health Sciences, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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Mattsson TO, Holm B, Michelsen H, Knudsen JL, Brixen K, Herrstedt J. Non-intercepted dose errors in prescribing anti-neoplastic treatment: a prospective, comparative cohort study. Ann Oncol 2015; 26:981-986. [PMID: 25632069 DOI: 10.1093/annonc/mdv032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/19/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The incidence of non-intercepted prescription errors and the risk factors involved, including the impact of computerised order entry (CPOE) systems on such errors, are unknown. Our objective was to determine the incidence, type, severity, and related risk factors of non-intercepted prescription dose errors. PATIENTS AND METHODS A prospective, comparative cohort study in two clinical oncology units. One institution used a CPOE system with no connection to the electronic patient record system, while the other used paper-based prescription forms. All standard prescriptions were included and reviewed. Doses were recalculated according to the guidelines of each institution, using the patient data as documented in the patient record, the paper-based prescription form, or the CPOE system. A non-intercepted prescription dose error was defined as ≥10% difference between the administered and the recalculated dose. RESULTS Data were collected from 1 November 2012 to 15 January 2013. A total of 5767 prescriptions were evaluated, 2677 from the institution using CPOE and 3090 from the institution with paper-based prescription. Crude analysis showed an overall risk of a prescription dose error of 1.73 per 100 prescriptions. CPOE resulted in 1.60 and paper-based prescription forms in 1.84 errors per 100 prescriptions, i.e. odds ratio (OR) = 0.87 [95% confidence interval (CI) 0.59-1.29, P = 0.49]. Fifteen different types of errors and four potential risk factors were identified. None of the dose errors resulted in the death of the patient. CONCLUSIONS Non-intercepted prescribing dose errors occurred in <2% of the prescriptions. The parallel CPOE system did not significantly reduce the overall risk of dose errors, and although it reduced the risk of calculation errors, it introduced other errors. Strategies to prevent future prescription errors could usefully focus on integrated computerised systems that can aid dose calculations and reduce transcription errors between databases.
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Affiliation(s)
- T O Mattsson
- Department of Oncology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense.
| | - B Holm
- Department of Oncology, Herlev Hospital, Copenhagen
| | - H Michelsen
- Department of Oncology, Herlev Hospital, Copenhagen
| | | | - K Brixen
- Department of Clinical Research, University of Southern Denmark, Odense; Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - J Herrstedt
- Department of Oncology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense
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Fasola G, Macerelli M, Follador A, Rihawi K, Aprile G, Mea VD. Health information technology in oncology practice: a literature review. Cancer Inform 2014; 13:131-9. [PMID: 25506195 PMCID: PMC4254653 DOI: 10.4137/cin.s12417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 11/05/2022] Open
Abstract
The adoption and implementation of information technology are dramatically remodeling healthcare services all over the world, resulting in an unstoppable and sometimes overwhelming process. After the introduction of the main elements of electronic health records and a description of what every cancer-care professional should be familiar with, we present a narrative review focusing on the current use of computerized clinical information and decision systems in oncology practice. Following a detailed analysis of the many coveted goals that oncologists have reached while embracing informatics progress, the authors suggest how to overcome the main obstacles for a complete physicians' engagement and for a full information technology adoption, and try to forecast what the future holds.
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Affiliation(s)
- G Fasola
- Department of Oncology, University Hospital, Udine, Italy
| | - M Macerelli
- Department of Oncology, University Hospital, Udine, Italy
| | - A Follador
- Department of Oncology, University Hospital, Udine, Italy
| | - K Rihawi
- Department of Oncology, University Hospital, Udine, Italy
| | - G Aprile
- Department of Oncology, University Hospital, Udine, Italy
| | - V Della Mea
- Department of Mathematics and Computer Science, University of Udine, Italy
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