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Study of the effect of standardized chemotherapy order forms on prescribing errors and anti-emetic cost

Hematology-Oncology Service, Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC, USA

J Aubrey Waddell, PharmD, BCOP

Hematology-Oncology Service, Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC, USA

Dominic A Solimando, Jr, MA, BCOP

Hematology-Oncology Service, Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC, USA, Oncology Pharmacy Services, Inc., Arlington, VA, USA

Paula Doulaveris, RPh, MHR

Hematology-Oncology Service, Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC, USA, US Army Medical Material Center-Southwest Asia (USAMMC-SWA), Qatar

Rickey Myhand, MD

Hematology-Oncology Service, Department of Pharmacy, Walter Reed Army Medical Center, Washington, DC, USA, Hematology-Oncology Service, Department of Medicine, Brooke Army Medical Center, Ft. Sam Houston, TX, USA

Objectives. Many anti-neoplastic medication errors and excessive use of serotonin antagonist anti-emetic agents might be prevented by the use of a standardized chemotherapy order form (SCOF). Several studies showing a reduction in prescribing errors or control of inappropriate anti-emetic use through the use of SCOFs have been reported. No previously published study reported SCOFs were used to reduce both prescribing errors and anti-emetic cost. This study attempts to measure these outcomes in a haematology-oncology pharmacy service.

Methods. The study consisted of a four-month control period, followed by a four-month test period following dissemination of the standardized order forms. In each period, prescriber errors and anti-emetic use were monitored. During the control period, using clinical studies from the primary literature and anti-emetic guidelines, 64 SCOFs representing the most commonly used chemotherapy regimens in the medical oncology and gynaecology oncology services were developed by the haematology-oncology pharmacy. Differences in prescribing error rate and anti-emetic cost were compared between each period and with the institution’s historic prescribing error rate.

Results. During the control period, 1078 orders for oral and parenteral granisetron and ondansetron with combined total acquisition cost of $76 454.64 and a mean cost of $70.92 were dispensed. During the test period, the pharmacy dispensed 1121 orders with an acquisition cost of $73 331.61 and a mean cost of $65.42. A savings of $3123.03 resulted from a reduction of the amount prescribed in the test period. The difference in mean cost per order between the two periods was significant (P B0.037). Fifty-three prescribing errors out of 3592 medication orders were detected in the control period, while 12 errors out of 3585 medication orders were detected during the test period. A significant difference (P B0.0001) was detected between the two periods. There was a significant difference (P B0.0001) between the control period and the institution’s historic prescribing error rate and no difference between the test period and the institution’s historic prescribing error rate.

Conclusion. SCOFs significantly reduced serotonin antagonist anti-emetic cost and prescribing error rate over a four-month period.

Key Words: anti-emetic guidelines • anti-emetics • anti-neoplastic regimen • medication error • prescribing errors • standardized chemotherapy orders

Journal of Oncology Pharmacy Practice, Vol. 11, No. 1, 21-30 (2005)
DOI: 10.1191/1078155205jp149oa


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