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Computerized Order Entry and Failure Modes and Effects Analysis

George R. Kim, MD; Allen R. Chen, MD, PhD; Robert J. Arceci, MD, PhD; Sandra H. Mitchell, RPh, MSIS; K. Michelle Kokoszka, RN; Denise Daniel, RN; Christoph U. Lehmann, MD

Arch Pediatr Adolesc Med. 2006;160:495-498.

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.

Author Affiliations: Divisions of Health Sciences Informatics (Drs Kim and Lehmann) and Pediatric Oncology (Drs Chen and Arceci and Mss Kokoszka and Daniel), The Johns Hopkins School of Medicine, and Department of Pharmacy, The Johns Hopkins Hospital (Ms Mitchell), Baltimore, Md.

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