Appl Clin Inform 2015; 06(04): 638-649
DOI: 10.4338/ACI-2015-03-RA-0027
Research Article
Schattauer GmbH

Safe Implementation of Computerized Provider Order Entry for Adult Oncology

D.B. Martin
1   Seattle Cancer Care Alliance, Seattle, WA, United States
,
D. Kaemingk
1   Seattle Cancer Care Alliance, Seattle, WA, United States
,
D. Frieze
2   Department of Pharmacy, University of Washington Medical Center/ Seattle Cancer Care Alliance, Seattle, WA, United States
,
P. Hendrie
1   Seattle Cancer Care Alliance, Seattle, WA, United States
,
T.H. Payne
3   Departments of Medicine, Health Services and Biomedical & Health Informatics, University of Washington, Seattle, WA, United States
› Author Affiliations
Further Information

Correspondence to:

Daniel Martin
Seattle Cancer Care Alliance
825 Eastlake Ave.E.
Seattle, WA 98109
Phone: (206) 288 1284   
Fax: (206) 732 2187   

Publication History

received: 17 March 2015

accepted in revised form: 28 August 2015

Publication Date:
19 December 2017 (online)

 

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.


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Conflicts of interest

None of the authors have any relationships with organizations or industry regarding the contents of this manuscript that could be viewed as potential conflicts of interest.

  • References

  • 1 Kohn LT, Corrigan JM, Donaldson MS. [editors]. To Err is Human. Building a safer health system. Institute of Medicine; Washington (DC): National Academies Press (US); 2000
  • 2 Blumenthal D, Tavenner M. The „meaningful use“ regulation for electronic health records. N Engl J Med, 2010; 363 (06) 501-504.
  • 3 Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc 2008; 15 (05) 585-600.
  • 4 Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, Vander Vliet M, Seger DL. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280 (15) 1311-1316.
  • 5 Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma’Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999; 6 (04) 313-321.
  • 6 Devine EB, Hansen RN, Wilson-Norton JL, Lawless NM, Fisk AW, Blough DK, Martin DP, Sullivan SD. The impact of computerized provider order entry on medication errors in a multispecialty group practice. J Am Med Inform Assoc 2010; 17 (01) 78-84.
  • 7 Kaushal R, Kern LM, Barron Y, Quaresimo J, Abramson EL. Electronic prescribing improves medication safety in community-based office practices. J Gen Intern Med 2010; 25 (06) 530-536.
  • 8 Reckmann MH, Westbrook JI, Koh Y, Lo C, Day RO. Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. J Am Med Inform Assoc 2009; 16 (05) 613-623.
  • 9 Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 14 (04) 415-423.
  • 10 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293 (10) 1197-1203.
  • 11 Adelman JS, Kalkut GE, Schechter CB, Weiss JM, Berger MA, Reissman SH, Cohen HW, Lorenzen SJ, Burack DA, Southern WN. Understanding and preventing wrong-patient electronic orders: a randomized controlled trial. J Am Med Inform Assoc 2013; 20 (02) 305-310.
  • 12 Nanji KC, Rothschild JM, Salzber C, Keohane CA, Zigmont K, Devita J, Gandhi TK, Dalal AK, Bates DW, Poon EG. Errors associated with outpatient computerized prescribing systems. J Am Med Inform Assoc 2011; 18 (06) 767-773.
  • 13 Warner J, Hochberg E. Where is the EHR in oncology?. J Natl Compr Canc Netw 2012; 10 (05) 584-588.
  • 14 Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR, LeFebvre KB, Schulmeister L, Jacobson JO. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. Oncol Nurs Forum 2013; 40 (03) 225-233.
  • 15 Bubalo J, Warden BA, Wiegel JJ, Nishida T, Handel E, Svoboda LM, Nguyen L, Edillo PN. Does applying technology throughout the medication use process improve patient safety with antineoplastics?. J Oncol Pharm Pract 2013; 20 (06) 445-460.
  • 16 Meisenberg BR, Wright RR, Brady-Copertino CJ. Reduction in chemotherapy order errors with computerized physician order entry. J Oncol Pract 2014; 10 (01) e5-e9.
  • 17 Collins CM, Elsaid KA. Using an enhanced oral chemotherapy computerized provider order entry system to reduce prescribing errors and improve safety. Int J Qual Health Care 2011; 23 (01) 36-43.
  • 18 Chen AR, Lehmann CU. Computerized provider order entry in pediatric oncology: design, implementation, and outcomes. J Oncol Pract 2011; 7 (04) 218-222.
  • 19 Cho E, Kim HJ, Kim GM, Kum J, Chung HK, Lyu CJ, Ahn JB, Shin SJ. Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. Int J Med Inform 2013; 82 (06) 504-513.
  • 20 Huertas Fernandez MJ, Baena-Canada JM, Martinez Bautista MJ, Arriola Arellano E, Garcia Palacios MV. Impact of computerised chemotherapy prescriptions on the prevention of medication errors. Clin Transl Oncol 2006; 8 (11) 821-825.
  • 21 Voeffray M, Pannatier A, Stupp R, Fucina N, Leyvraz S, Wasserfallen JB. Effect of computerisation on the quality and safety of chemotherapy prescription. Qual Saf Health Care 2006; 15 (06) 418-421.
  • 22 Hoffman JM, Baker DK, Howard SC, Laver JH, Shenep JL. Safe and successful implementation of CPOE for chemotherapy at a en’s cancer center. J Natl Compr Canc Netw 2011; 9 (Suppl. 03) S36-S50.
  • 23 Kantarjian HM, O’Brien S, Smith TL, Cortes J, Giles FJ, Beran M, Pierce S, Huh Y, Andreeff M, Koller C, Ha CS, Keating MJ, Murphy S, Freireich EJ. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol 2000; 18 (03) 547-561.
  • 24 Kim GR, Chen AR, Arceci RJ, Mitchell SH, Kokoszka KM, Daniel D, Lehmann CU. Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis. Arch Pediatr Adolesc Med 2006; 160 (05) 495-498.
  • 25 Cullen DJ, Bates DW, Small SD, Cooper JB, Nemeskal AR, Leape LL. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Jt Comm J Qual Improv 1995; 21 (10) 541-548.

Correspondence to:

Daniel Martin
Seattle Cancer Care Alliance
825 Eastlake Ave.E.
Seattle, WA 98109
Phone: (206) 288 1284   
Fax: (206) 732 2187   

  • References

  • 1 Kohn LT, Corrigan JM, Donaldson MS. [editors]. To Err is Human. Building a safer health system. Institute of Medicine; Washington (DC): National Academies Press (US); 2000
  • 2 Blumenthal D, Tavenner M. The „meaningful use“ regulation for electronic health records. N Engl J Med, 2010; 363 (06) 501-504.
  • 3 Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc 2008; 15 (05) 585-600.
  • 4 Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, Vander Vliet M, Seger DL. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280 (15) 1311-1316.
  • 5 Bates DW, Teich JM, Lee J, Seger D, Kuperman GJ, Ma’Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999; 6 (04) 313-321.
  • 6 Devine EB, Hansen RN, Wilson-Norton JL, Lawless NM, Fisk AW, Blough DK, Martin DP, Sullivan SD. The impact of computerized provider order entry on medication errors in a multispecialty group practice. J Am Med Inform Assoc 2010; 17 (01) 78-84.
  • 7 Kaushal R, Kern LM, Barron Y, Quaresimo J, Abramson EL. Electronic prescribing improves medication safety in community-based office practices. J Gen Intern Med 2010; 25 (06) 530-536.
  • 8 Reckmann MH, Westbrook JI, Koh Y, Lo C, Day RO. Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. J Am Med Inform Assoc 2009; 16 (05) 613-623.
  • 9 Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 14 (04) 415-423.
  • 10 Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293 (10) 1197-1203.
  • 11 Adelman JS, Kalkut GE, Schechter CB, Weiss JM, Berger MA, Reissman SH, Cohen HW, Lorenzen SJ, Burack DA, Southern WN. Understanding and preventing wrong-patient electronic orders: a randomized controlled trial. J Am Med Inform Assoc 2013; 20 (02) 305-310.
  • 12 Nanji KC, Rothschild JM, Salzber C, Keohane CA, Zigmont K, Devita J, Gandhi TK, Dalal AK, Bates DW, Poon EG. Errors associated with outpatient computerized prescribing systems. J Am Med Inform Assoc 2011; 18 (06) 767-773.
  • 13 Warner J, Hochberg E. Where is the EHR in oncology?. J Natl Compr Canc Netw 2012; 10 (05) 584-588.
  • 14 Neuss MN, Polovich M, McNiff K, Esper P, Gilmore TR, LeFebvre KB, Schulmeister L, Jacobson JO. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. Oncol Nurs Forum 2013; 40 (03) 225-233.
  • 15 Bubalo J, Warden BA, Wiegel JJ, Nishida T, Handel E, Svoboda LM, Nguyen L, Edillo PN. Does applying technology throughout the medication use process improve patient safety with antineoplastics?. J Oncol Pharm Pract 2013; 20 (06) 445-460.
  • 16 Meisenberg BR, Wright RR, Brady-Copertino CJ. Reduction in chemotherapy order errors with computerized physician order entry. J Oncol Pract 2014; 10 (01) e5-e9.
  • 17 Collins CM, Elsaid KA. Using an enhanced oral chemotherapy computerized provider order entry system to reduce prescribing errors and improve safety. Int J Qual Health Care 2011; 23 (01) 36-43.
  • 18 Chen AR, Lehmann CU. Computerized provider order entry in pediatric oncology: design, implementation, and outcomes. J Oncol Pract 2011; 7 (04) 218-222.
  • 19 Cho E, Kim HJ, Kim GM, Kum J, Chung HK, Lyu CJ, Ahn JB, Shin SJ. Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. Int J Med Inform 2013; 82 (06) 504-513.
  • 20 Huertas Fernandez MJ, Baena-Canada JM, Martinez Bautista MJ, Arriola Arellano E, Garcia Palacios MV. Impact of computerised chemotherapy prescriptions on the prevention of medication errors. Clin Transl Oncol 2006; 8 (11) 821-825.
  • 21 Voeffray M, Pannatier A, Stupp R, Fucina N, Leyvraz S, Wasserfallen JB. Effect of computerisation on the quality and safety of chemotherapy prescription. Qual Saf Health Care 2006; 15 (06) 418-421.
  • 22 Hoffman JM, Baker DK, Howard SC, Laver JH, Shenep JL. Safe and successful implementation of CPOE for chemotherapy at a en’s cancer center. J Natl Compr Canc Netw 2011; 9 (Suppl. 03) S36-S50.
  • 23 Kantarjian HM, O’Brien S, Smith TL, Cortes J, Giles FJ, Beran M, Pierce S, Huh Y, Andreeff M, Koller C, Ha CS, Keating MJ, Murphy S, Freireich EJ. Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia. J Clin Oncol 2000; 18 (03) 547-561.
  • 24 Kim GR, Chen AR, Arceci RJ, Mitchell SH, Kokoszka KM, Daniel D, Lehmann CU. Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis. Arch Pediatr Adolesc Med 2006; 160 (05) 495-498.
  • 25 Cullen DJ, Bates DW, Small SD, Cooper JB, Nemeskal AR, Leape LL. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Jt Comm J Qual Improv 1995; 21 (10) 541-548.