Overview: As part of a strategy to facilitate the safe administration of chemotherapy, the joint Pediatric Oncology Program at Dana-Farber Cancer Institute and Children's Hospital, Boston has created a Pediatric Chemotherapy Order Entry System (COE). With administrative support, this system was developed by a team consisting of a project manager, nurse, pharmacist, physician and programmers. COE orders may be created “from scratch” or from templates created for the most frequently used and complex treatment plans. Because of the time needed to develop a computerized system, paper templates were created as an interim safety measure, and have been in use for the past 4 years. These order sets have gradually been entered into COE, with a goal of no paper chemotherapy orders by April, 2003.
Process: Although a computerized system may be an unrealistic technological and financial commitment for many programs, the use of paper templates is easily initiated and provides many safeguards to improve the prescribing and administration of chemotherapy and supportive care medications. In this program, both computerized and paper templates are created by nursing and then reviewed and approved by nursing, pharmacy and medicine. This teamwork ensures that the final product works for all disciplines and thus, requires fewer subsequent changes to orders prior to chemotherapy administration.
Outcome: Both computerized and paper templates offer safety features not ensured when ordering from scratch. In addition to the expected benefits of more legible, complete, concise orders, the initiation of templated orders has led to the standardization of care. These factors have improved the prescribing, review and delivery of care and have significantly decreased the re-work frequently involved in these processes. The benefits we have realized from the use of both computerized and paper templates have translated into fewer potential errors and the facilitation of work for nursing, pharmacy and medicine.
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