Safe chemotherapy administration: Using failure mode and effects analysis in computerized prescriber order entry

Computerized prescriber order entry (CPOE) has enabled many institutions to meet a changing and challenging health care market by altering how medications are processed.1 Over the past several years, patient safety has become a key issue for all health care institutions, with serious questions and public concerns having been raised regarding medical errors.2 Medication errors are of particular concern because of their increasing occurrence and preventable nature. Of the top 10 causes of death, medication errors ranked number 5 in 1999.2 Although opportunities for medication errors exist at every stage of the medication-use process, the majority of errors are made during the ordering stage.3,4 The Hospital of Saint Raphael in New Haven, Connecticut, implemented CPOE to enhance patient safety for medication management, but a decision was made to exclude i.v. chemotherapy drugs from the system because the CPOE system did not meet all of the requirements for safe chemotherapy administration. Specifically, the limited functionality of the i.v. medication administration record for large-volume parenterals and the associated electronic medication record did not provide a visual sequencing of events for safe chemotherapy administration.