Error Reduction in Pediatric Chemotherapy: Computerized Order Entry and Failure Modes and Effects Analysis

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Abstract

Objective

To implement and evaluate the impact of computerized provider order entry (CPOE) on reducing ordering errors in pediatric chemotherapy.

Design

Before-and-after study from 2001 to 2004.

Setting

Pediatric Oncology in an academic medical center.

Intervention

Implementation of a CPOE system guided by multidisciplinary failure modes and effects analysis into pediatric chemotherapy.

Main Outcome Measures

Completion data on chemotherapy steps of high morbidity/mortality potential if missed (as determined by attending oncologists) from 1259 pre-CPOE paper and 1116 post-CPOE pediatric chemotherapy orders.

Results

After CPOE deployment, daily chemotherapy orders were less likely to have improper dosing (relative risk [RR], 0.26; 95% confidence interval [CI], 0.11–0.61), incorrect dosing calculations (RR, 0.09; 95% CI, 0.03–0.34), missing cumulative dose calculations (RR, 0.32; 95% CI, 0.14–0.77), and incomplete nursing checklists (RR, 0.51; 95% CI, 0.33–0.80). There was no difference in the likelihood of improper dosing on treatment plans and a higher likelihood of not matching medication orders to treatment plans (RR, 5.4; 95% CI, 3.1–9.5).

Conclusion

Failure modes and effects analysis–guided CPOE reduced ordering errors in pediatric chemotherapy and provided data for further improvements.

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