Open Access Research article

Chemotherapy prescribing errors: an observational study on the role of information technology and computerized physician order entry systems

Marianna Aita1, Ornella Belvedere12, Elisa De Carlo1, Laura Deroma3, Federica De Pauli1, Lorena Gurrieri1, Angela Denaro4, Loris Zanier5 and Gianpiero Fasola1*

Author Affiliations

1 Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy

2 Department of Oncology, York Teaching Hospital, York, UK

3 Regional Coordinator Centre for Rare Diseases, University Hospital of Udine, Udine, Italy

4 Department of Medical Oncology, University Hospital of Trieste, Trieste, Italy

5 Health Directorate, Friuli Venezia-Giulia Region, Trieste, Italy

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BMC Health Services Research 2013, 13:522  doi:10.1186/1472-6963-13-522

Published: 17 December 2013

Abstract

Background

Chemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used.

Methods

Up to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale.

Results

Eight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome.

Conclusions

Chemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.

Keywords:
Adverse drug event; Chemotherapy; Computerized physician order entry (CPOE) systems; Information technology; Prescribing errors; Outpatient