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Related Experiment Videos

Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis.

George R Kim1, Allen R Chen, Robert J Arceci

  • 1Division of Health Sciences Informatics, The Johns Hopkins School of Medicine, Baltimore, MD 21287-3200, USA. grkim@jhmi.edu

Archives of Pediatrics & Adolescent Medicine
|May 3, 2006
PubMed
Summary

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Computerized provider order entry (CPOE) significantly reduced pediatric chemotherapy ordering errors, including dosing and calculation mistakes. This system enhancement improved patient safety and informed future quality improvements in pediatric oncology.

Area of Science:

  • Pediatric Oncology
  • Health Informatics
  • Patient Safety

Background:

  • Ordering errors in pediatric chemotherapy pose significant risks.
  • Traditional paper-based systems are prone to errors.
  • Need for improved safety and efficiency in chemotherapy ordering.

Purpose of the Study:

  • To implement and evaluate the impact of Computerized Provider Order Entry (CPOE) in pediatric chemotherapy.
  • To assess CPOE's effectiveness in reducing ordering errors.
  • To identify areas for further system improvement.

Main Methods:

  • A before-and-after study was conducted from 2001 to 2004.
  • A multidisciplinary failure modes and effects analysis guided CPOE implementation.
  • Data analyzed included 1259 pre-CPOE paper orders and 1116 post-CPOE electronic orders for high-risk chemotherapy steps.

Related Experiment Videos

Main Results:

  • CPOE significantly reduced improper dosing (RR, 0.26), incorrect dosing calculations (RR, 0.09), and missing cumulative dose calculations (RR, 0.32).
  • Incomplete nursing checklists also decreased post-CPOE implementation (RR, 0.51).
  • However, there was an increased likelihood of medication orders not matching treatment plans (RR, 5.4).

Conclusions:

  • Failure modes and effects analysis-guided CPOE implementation effectively reduced critical ordering errors in pediatric chemotherapy.
  • The system provided valuable data for continuous quality improvement.
  • Ongoing vigilance is needed to address medication order-to-treatment plan discrepancies.