- Volume 17 Issue 4
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Prescription Errors with Chemotherapy: Quality Improvement through Standardized Order Templates
- Saad, Aline (Department of Pharmacy Practice School of Pharmacy Lebanese American University) ;
- Der-Nigoghossian, Caroline A. (Lebanese American University Byblos) ;
- Njeim, Rachel (Lebanese American University Byblos) ;
- Sakr, Riwa (Holy Spirit University of Kaslik Jounieh) ;
- Salameh, Pascale (Department of Pharmacy Practice School of Pharmacy Lebanese American University) ;
- Massoud, Marcel (Holy Spirit University of Kaslik Jounieh)
- Published : 2016.06.01
Background: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. Initial Assessment: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. Choice of solution: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. Implementation: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. Evaluation: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. Lessons Learned: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.
Patient and medication safety;quality improvement;standardization of care;and chemotherapy order
- ASHP (2002). guidelines on preventing medication errors with antineoplastic agents. Am J Health Syst Pharm, 59, 1648-68.
- Birner AM, Bedell MK, Avery JT, Ernstoff MS (2006). Program to support safe administration of oral chemotherapy. J Oncol Pract, 2, 5-6. https://doi.org/10.1200/JOP.2.1.5
- Dreyfuss JH (2010). New joint outpatient chemotherapy administration standards. CA Cancer J Clin, 60, 66-7. https://doi.org/10.3322/caac.20065
- Dumasia L, Harris E, Drelichman A (2006). Quality performance improvement with the implementation of standard chemotherapy order forms. J Oncol Pract, 2, 104-7. https://doi.org/10.1200/JOP.2.3.104
- Fyhr A and Akselsson R (2012). Characteristics of medication errors with parenteral cytotoxic drugs. Eur J Cancer Care (Engl), 21, 606-13. https://doi.org/10.1111/j.1365-2354.2012.01331.x
- Hamza NA, Sallam SA, El-Nimr NE (2013). Rates and types of prescribing errors and related interventions in oncology. Int J Curr Microbiol App Sci, 2, 435-45.
- Harris T and Northfelt DW (2005). Chemotherapy error: practical approaches to increasing patient safety. J Patient Saf, 1, 215-9. https://doi.org/10.1097/01.jps.0000215340.80935.d0
- Harris N, Badr LK, Saab R, Khalidi A (2014). Caregivers’ perception of drug administration safety for pediatric oncology patients. J Pediatr Oncol Nurs, 31, 95-103. https://doi.org/10.1177/1043454213517749
- Hartel MJ, Staub LP, Roder C, Eggli S (2011). High incidence of medication documentation errors in a Swiss university hospital due to the handwritten prescription process. BMC Health Serv Res, 11, 199. https://doi.org/10.1186/1472-6963-11-199
- Institute for Safe Medication Practices (ISMP) ISMP Guidelines (2014). http://www.ismp.org/Tools/guidelines/default.asp.
- Kloth DD (2010). Guide to the Prevention of Chemotherapy Medication Errors: Strategies To Prevent Chemotherapy Errors 2nd edition, Clinical Oncol, .
- Li EC, Hinkel JM, Gallagher L, et al (2009). NCCN chemotherapy order templates: enhancing patient safety through standardization. J Clin Oncol, 27, 17537.
- Mathaiyan J, Jain T, Dubashi B, Reddy KS, Batmanabane G (2015). Prescription errors in cancer chemotherapy: Omissions supersede potentially harmful errors. J Pharmacol Pharmacother, 6, 83-7. https://doi.org/10.4103/0976-500X.155484
- Meisenberg BR, Wright RR (2014). and Brady-copertino CJ: Reduction in chemotherapy order errors with computerized physician order entry. J Oncol Pract, 10, 5-9. https://doi.org/10.1200/JOP.2013.001304
- Northfelt DW, Allbritton DW, Parra LS, et al (2003). Medication errors in cancer therapy: review and proposal for systematic study. Proc Am Soc Clin Oncol, 22, 542.
- Phillips J, Beam S, Brinker A, et al (2001). Retrospective analysis of mortalities associated with medication errors. Am J Health Syst Pharm, 58, 1835-41.
- Ranchon F, Salles G, Spath HM, et al (2011). Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs. BMC Cancer, 11, 478. https://doi.org/10.1186/1471-2407-11-478
- Shaikh BS, Mowat RB, Parr DD (2004). Chemotherapy ordering process: Safety and efficiency considerations. J Clin Oncol, 22, 6110. https://doi.org/10.1200/jco.2004.22.14_suppl.6110
- Schulmeister L (2006) Preventing chemotherapy errors. Oncologist, 11, 463-8. https://doi.org/10.1634/theoncologist.11-5-463
- Serrano-Fabia A, Albert-Mari A, Almenar-Cubells D and Jimenez-Torres NV (2010). Multidisciplinary system for detecting medication errors in antineoplastic chemotherapy. J Oncol Pharm Pract, 16, 105-12. https://doi.org/10.1177/1078155209340482
- The 8-Step Process for Leading Change (2015). Available at: http://www.kotterinternational.com/the-8-step-process-forleading-change/. Accessed August 12, 2015.
- Walsh KE, Dodd KS, Seetharaman K, et al (2009). Medication errors among adults and children with cancer in the outpatient setting. J Clin Oncol, 27, 891-6. https://doi.org/10.1200/JCO.2008.18.6072
- Zeitoun AA, Nassif JG (2013). Evaluation of anti-emetic use in chemotherapy-induced nausea and vomiting in a third world country (Lebanon). J Eval Clin Pract, 19, 68-75. https://doi.org/10.1111/j.1365-2753.2011.01770.x
- Recommendations by the Spanish Society of Hospital Pharmacy, the Spanish Society of Oncology Nursing and the Spanish Society of Medical Oncology for the safe management of antineoplastic medication in cancer patients pp.1699-3055, 2018, https://doi.org/10.1007/s12094-018-1945-x