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

Kim GR, Chen AR, Arceci RJ, Mitchell SH, Kokoszka KM, Daniel D, Lehmann CU

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

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.

Published 2 May 2006 in Arch Pediatr Adolesc Med, 160(5): 495-8.
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