Computerized prescriber order entry in the outpatient oncology setting: from evidence to meaningful use

This is a review of Kukreti, Cosby, Cheung, Lankshear, and ST Computerized Prescriber Order Entry 2014 article, Computerized prescriber order entry in the outpatient oncology setting: From evidence to meaningful use.

Background

Computerized physician order entry (CPOE) is a health IT component that allows clinicians to directly place a medication order during a patient visit. The goal of CPOE is to provide overall better care for patients through reducing errors at the time of ordering.

The authors in this article performed a systemic review of CPOE used in an oncology setting during the administration of chemotherapy. In previous articles, there has been mixed reviews for the use of CPOE in healthcare. More times than less, the results are beneficial. Now, the authors want to see if based on previous research studies, the benefits from using CPOE can be implemented in order to reduce the high amount of adverse events caused by wrongful ordering.

Methods

The authors of the article chose four well-known databases MEDLINE, EMBASE, CINAHL, and COMPENDEX for relevant evidence. Articles were included in the review if they met certain criteria:

• Published in English-language
• Matched reports of CPOE in the oncology setting for medication error reduction
• Generated outcomes (for example, effects on practice, implementation strategies)

Results

After the searches of the respective databases were completed, there were a total of 5,642 hits. Once the exclusion and inclusion criterion was added, only 475 papers were selected for retrieval and full review. In total, seven unique quantitative and two unique qualitative papers met the eligibility criteria for the systematic review.

When the results are analyzed in greater detail, there were five articles showing that CPOE reduced chemotherapy medication errors. The articles chosen were based on studies looking at the amount of errors generated by hand-written medication orders vs. CPOE medication orders. In all of the articles, there was a significant difference in the amount of errors of hand-written orders vs. the computerized orders.

In the four articles where the CPOE system posed as a negative, the results yielded had no statistical significance.

Discussion

The results presented in the article show plausibility on the effectiveness of CPOE within the oncology setting. The results match other systemic reviews, which have also seen the positive and negative outcomes of CPOE implementation.

Conclusions

Based on a review of the literature, the following 6 strategies are presented:

• CPOE systems should be used in outpatient chemotherapy delivery to reduce chemotherapy-related medication errors.
• Clinical, technical, and leadership champions are vital to support the successful adoption of CPOE within an organization.
• A multidisciplinary team approach should be used in the design, selection, workflow evaluation, implementation or evaluation (or both), and ongoing monitoring of the CPOE system.
• To enhance adoption by clinicians, CPOE processes that complement current practice and workflow processes should be ensured.
• CPOE systems, clinical decision supports, and associated interface elements must be carefully designed to reduce the potential for error.
• Development and implementation of a risk assessment process to identify actual or potential unanticipated consequences and the generation of new errors are warranted, as is the development of strategies to modify the system accordingly.

Comments

When I first began to read the article I believed that all of the article the authors chose were going to show positive results for the implementation of CPOE. The reality is that there are still many obstacles in implementing technology into healthcare. It is important that the staff gets familiarized with the system either by practicing or receiving adequate training before fully committing to using the system. Tools such as CPOE and CDS have great potential to improve the work of a clinician and provide overall better care for patients.

Related article review: Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients