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Arch Pediatr Adolesc Med. 2006 May;160(5):495-8.

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

Author information

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

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.

Comment in

  • Primum non nocere. [Arch Pediatr Adolesc Med. 2006]
PMID:
16651491
[PubMed - indexed for MEDLINE]
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