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Chemotherapy Error Reduction: A Multidisciplinary Approach to Create Templated Order Sets

Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115

Patricia Branowicki, MS, RN

Children’s Hospital, Boston, Massachusetts

Jill Brace O’Neill, MS, RN-CS, PNP

Children’s Hospital/Dana Farber Cancer Institute, Boston, Massachusetts

Barbara L. Marino, PhD, RN

PHT Corporation, Charlestown, Massachusetts

Amy Billett, MD

Harvard Medical School, Division of Hematology/Oncology, Children’s Hospital, Boston, Massachusetts

More than 48,000 newly diagnosed cancer patients can expect to have some adverse events related to their care each year. Historically, 20% of these adverse events have been medication related, and two thirds have been thought to be preventable. Since the majority of these errors occurred during the order writing process, the prioritized changes made at the joint pediatric program for Children’s Hospital, Boston, and Dana-Farber Cancer Institute have been the initiation of templated orders and the development of a computerized order entry system. The goal of this initiative was to decrease errors related to chemotherapy administration by creating legible, complete, clearly defined order sets, and at the same time, to make order writing and reviewing more efficient. Chemotherapy templates were created using a consistent format and a rigorous multidisciplinary review process. Each order set includes the following: identification of the patient and cycle of chemotherapy to be given, criteria necessary to receive chemotherapy, chemotherapy orders with modifications if appropriate, and supportive care orders. Templated order sets have reduced the duplication of work efforts by significantly reducing the number of changes made during the order verification process; orders are more complete, and standardization has occurred.

Key Words: chemotherapy • error • orders

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