You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 160 No. 5, May 2006 TABLE OF CONTENTS
  Archives
  •  Online Features
  Article
 This Article
 •Full text
 •PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on ISI (9)
 •Contact me when this article is cited
 Related Content
 •Related letters
 •Similar articles in this journal
 Topic Collections
 •Quality of Care, Other
 •Pediatrics, Other
 •Drug Therapy
 •Alert me on articles by topic

Error Reduction in Pediatric Chemotherapy

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.


RELATED LETTERS

Primum Non Nocere
David Dickens, Dianne Sinsabaugh, and Brenda Winger
Arch Pediatr Adolesc Med. 2006;160(11):1185.
EXTRACT | FULL TEXT  

Primum Non Nocere—Reply
George R. Kim, Allen R. Chen, Robert J. Arceci, and Christoph U. Lehmann
Arch Pediatr Adolesc Med. 2006;160(11):1185-1186.
EXTRACT | FULL TEXT  


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review
Ammenwerth et al.
J. Am. Med. Inform. Assoc. 2008;15:585-600.
ABSTRACT | FULL TEXT  

A Risk Analysis Method to Evaluate the Impact of a Computerized Provider Order Entry System on Patient Safety
Bonnabry et al.
J. Am. Med. Inform. Assoc. 2008;15:453-460.
ABSTRACT | FULL TEXT  

Hidden danger, obvious opportunity: error and risk in the management of cancer
Munro
Br. J. Radiol. 2007;80:955-966.
FULL TEXT  

Strategic approach for improving the medication-use process in health systems: The high-performance pharmacy practice framework
Vermeulen et al.
Am J Health Syst Pharm 2007;64:1699-1710.
ABSTRACT | FULL TEXT  

Electronic Prescribing Systems in Pediatrics: The Rationale and Functionality Requirements
Gerstle et al.
Pediatrics 2007;119:e1413-e1422.
ABSTRACT | FULL TEXT  

Effect of computerisation on the quality and safety of chemotherapy prescription
Voeffray et al.
Qual Saf Health Care 2006;15:418-421.
ABSTRACT | FULL TEXT  

Primum non nocere.
Dickens et al.
Arch Pediatr Adolesc Med 2006;160:1185-1185.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2006 American Medical Association. All Rights Reserved.