Prevention of Chemotherapy Prescription Errors with Hematology/Oncology Computerized Physician Order Entry System-Experience from a Medical Center

Background: Chemotherapy is high-risk procedure in Hematology/Oncology practices. We designed a computerized physician order entry (CPOE) system specifically for prescribing chemotherapy in order to reduce prescription errors, thus improving patient safety.Materials and Methods: Healthcare failure mode and effects analysis (HFMEA) methodology were used to evaluate chemotherapy prescription and dispensing processes and several kinds of prescription errors were identified. A Java-based CPOE system for chemotherapy prescription was designed in cooperation with Cathay General Hospital's Information Technology Department and has been on line since April 2008. Records prior to and after the CPOE system usage (April 2007 to December 2010) were collected to analyze the improvement of prescription errors.Results: After instigation of CPOE system in Cathay General Hospital in April 2008, 96.0% of chemotherapy orders were prescribed through this system as of 2010. The total prescription error rate was reduced from 4% before CPOE to 0.71% after CPOE. There were 54 errors in the CPOE group and 410 errors in the non-CPOE group (p＜0.001), with error rates of 0.33% in the CPOE group and 3.63% in the non-CPOE group from April 2007 to December 2010. The most common prescription error was wrong date prior to CPOE online, which declined after CPOE. Wrong dosage became the most common prescription error after CPOE usage; however, this error rate was still lower compared to prior-CPOE dosage error (0.98% before CPOE and 0.26% after CPOE).Conclusions: Our CPOE chemotherapy prescription system has been demonstrated to be user-friendly and convenient in daily clinical practice, with improved prescription error rate. This system also provides complete patient health records for practice and can be data mined for academic research.