Summary
Background: Oncology has lagged in CPOE adoption due to the narrow therapeutic index of chemotherapy
drugs, individualized dosing based on weight and height, regimen complexity, and workflows
that include hard stops where safety checks are performed and documented.
Objectives: We sought to establish CPOE for chemotherapy ordering and administration in an academic
teaching institution using a commercially available CPOE system.
Methods: A commercially available CPOE system was implemented throughout the hospital. A multidisciplinary
team identified key safety gaps that required the development of a customized complex
order display and a verification documentation workflow. Staff reported safety events
were monitored for two years and compared to the year prior to go live.
Results: A workflow was enabled to capture real-time provider verification status during the
time from ordering to the administration of chemotherapy. A customized display system
was embedded in the EMR to provide a single screen view of the relevant parameters
of chemotherapy doses including current and previous patient measurements of height
and weight, dose adjustments, provider verifications, prior chemotherapy regimens,
and a synopsis of the standard regimen for reference. Our system went live with 127
chemotherapy plans and has been expanded to 189. Staff reported safety events decreased
following implementation, particularly in the area of prescribing and transcribing
by the second year of use.
Conclusions: We observed reduced staff reported safety events following implementation of CPOE
for inpatient chemotherapy using an electronic verification workflow and an embedded
custom clinical decision support page. This implementation demonstrates that CPOE
can be safely used for inpatient chemotherapy, even in an extremely complex environment.
Keywords
CPOE - chemotherapy - patient safety - transplant
