An electronic chemotherapy administration safety checklist: The safe transition from paper to computer

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Background: This abstract describes the successful implementation of an electronic chemotherapy administration safety checklist and the outcomes that led to further enhancement of safe chemotherapy administration. The purpose of this abstract is to give an overview of the processes in transitioning from a paper checklist to an electronic version. Following the implementation of a paper chemotherapy administration safety checklist in 2002, this cancer center realized a significant reduction in chemotherapy errors reaching patients. The checklist became a model for many practitioners across the U.S. Our implementation of the Sunrise computerized provider order entry (CPOE) system in oncology inpatient units in 10/2009 included support for all of the 2009 ASCO/ONS chemotherapy ordering standards, and featured a two-way interface with the pharmacy system, and an electronic medication administration record. In the 12 months following its deployment, the rate of chemotherapy errors that reached the patient fell from 2.71 per 100 chemotherapy admissions using our paper system to 1.11 per 100 chemotherapy admissions using CPOE. With the advent of electronic documentation it became apparent that the paper checklist was outdated. Methods: An electronic chemotherapy checklist was implemented, replacing a paper version that had been in use for almost a decade. The proper design and implementation of the electronic version were essential to ensure that the safety achieved with the paper checklist was not compromised. After pilot testing, the checklist was implemented. Results: The electronic chemotherapy checklist was accepted by staff and resulted in a decrease in errors reaching the patient. Conclusions: The safe administration of chemotherapy is the number one priority at our cancer center. To our surprise the electronic checklist has been a welcomed addition to our armamentarium against chemotherapy errors. The checklist has enhanced independent safety checks due to required independent sign-on of the electronic system. The checklist also heightened awareness of chemotherapy safety checks, which were unchanged, leading us to believe that the paper version had become somewhat ineffective.