Table 2.
Outcomes of infusional chemotherapy electronic prescribing interventions in hospital and ambulatory care settings
| Reference | Study design | Outcomes of interest | Impact of electronic prescribing on outcomes | Sample size and statistical analysis |
|---|---|---|---|---|
| Meisenberg et al14 | Quasi-experimental sequential design comparing handwritten orders, preprinted order sets, and CPOE prescribing | Problem rate (eg, missing patient information, inappropriate supportive care measures) Error rate (eg, wrong dose calculation, frequency, drug or supportive treatment omission) |
Problem rate (95% CI) Handwritten orders: 30.6% (28.7%–32.5%) Preprinted order sets: 12.6% (11.3%–13.9%) CPOE orders: 2.2% (1.9%–2.7%) Error rate (95% CI) Handwritten orders: 4.2% (3.5%–5.0%) Preprinted order sets: 1.5% (1.1%–1.9%) CPOE orders: 0.1% (0.04%–0.2%) |
2,216 handwritten; 2,480 preprinted order sets and 5,142 CPOE order sets Two-sample proportions test (chi-square test) |
| Elsaid et al21 | Quasi-experimental design in the form of interrupted time series with segmented regression | Monthly prevented prescribing errors per 1,000 chemotherapy doses during the pre-implementation, implementation, and post-implementation phases | Difference in prevented prescribing errors per 1,000 chemotherapy doses (implementation–pre-implementation) (95% CI): -5.1 (-9.9, -0.2) Difference in prevented prescribing errors per 1,000 chemotherapy doses (post-implementation–implementation) (95% CI): -11.5 (-21.8, -1.2) |
28,560 doses (pre-implementation) 37,808 doses (implementation) 43,206 doses (post-implementation) Statistical comparisons were conducted using linear regression analysis |
| Hoffman et al10 | No formal study was conducted | Reporting of patient safety events related to CPOE | No medication events attributed to CPOE caused harm | N/A |
| Harshberger et al15 Brockstein et al16 |
Retrospective chart review | Chemotherapy documentation completeness in EHR/CPOE and handwritten orders of select chemotherapy regimens Satisfaction of clinical staff with EHR/CPOE and handwritten orders |
Significant increase in regimen completeness scores in the EHR/CPOE system compared with handwritten orders. Increase in overall satisfaction rating by nurses, pharmacists, and physicians in the EHR/CPOE system compared with handwritten orders. |
45 charts in the EHR/CPOE group and 45 charts in the handwritten group. Satisfaction survey was administered to 33 nurses, 8 pharmacists, and 5 physicians. Statistical comparisons were conducted using two-sample proportions test (chi-square test) |
| Small et al18 | Quasi-experimental design comparing error rates in chemotherapy prescriptions using spreadsheet templates versus using CPOE | Error rate using spreadsheet chemotherapy prescriptions versus error rate using CPOE | Error rate and RR (95% CI) Spreadsheet method: 20.4% (17.2%–23.9%) Computerized method: 11.8% (10.1%–13.6%) RR 0.57 (0.47–0.72). |
314 spreadsheet prescriptions 1,339 computerized prescriptions Chi-square test and RR for errors with computerized versus spreadsheet prescribing estimated using Poisson regression |
| Huertas Fernández et al19 | Two-arm observational study comparing error rates in handwritten and computerized prescriptions | Error rate using handwritten prescriptions versus CPOE prescriptions | Handwritten: errors were detected in 100% of prescriptions CPOE: errors were detected in 13% of prescriptions Median (range) number of errors per prescription Handwritten: 5 (1–12) CPOE: 0 (0–1) |
30 handwritten prescriptions 30 CPOE prescriptions Two-sample proportions test (chi-square test) |
| Kim et al17 | Before and after comparing chemotherapy process using handwritten prescriptions versus CPOE prescriptions | Correct completion rates of steps of high importance as determined by oncologists, eg, proper medication dose for the regimen, correct dose calculation, and nurse review documentation | RR (95% CI) of improper dosing: 0.26 (0.11–0.61) RR (95% CI) of incorrect dosing calculation: 0.09 (0.03–0.34) RR (95% CI) of incomplete nursing check: 0.51 (0.33–0.80) |
1,250 handwritten prescriptions 1,116 CPOE prescriptions |
| Voeffray et al20 | Before and after comparing error rates in handwritten prescriptions versus CPOE prescriptions | Error rate using handwritten prescriptions versus CPOE prescriptions | Error rate (95% CI) Handwritten prescriptions: 15% (13%–18%) CPOE prescriptions: 0.6% (0.3%–1.4%) |
940 handwritten prescriptions 527 CPOE prescriptions |
Abbreviations: CI, confidence interval; CPOE, computerized provider order entry; EHR, electronic health records; N/A, not available; RR, relative risk.