Digital Chemotherapy Protocols: an outstanding debt

In Chile, a medication error occurs in 1 out of 3 patients during hospitalization (ME) [1]. In children, some studies have found that this proportion increases more than 2 times [2-3]. And within ME, chemotherapy errors rank second in fatal o serious consequences for patients [4], due to their vulnerable immune system and lower tolerance to drug dose variations [5].

Chemotherapy treatment protocols are complex and may require customization to patient’s health condition [6]: each therapeutic cycle may last months, several medication may be administered during each cycle (5, 10 or more), with dose variations and different routes for administration, each dose requires calculations based on patient weight, medication toxicity, and other factors that may change over time. This complexity may explain why in Chile chemotherapy protocols’ plan and administration is registered in paper, which may result in medication errors that put patients at risk.

International evidence has found that digital chemotherapy protocols decrease medication errors during prescription by 30% or more [7-10]. This result is obtained with computerized assistance, including: use of updated protocols, automatic medication dose calculation, alert about potentially harmful medications’ interactions or incomplete prescriptions, suggest medication routes of administration, among others. Information systems that incorporate these functionalities are known as Clinical Decision Support Systems (CDSS): their main objective is to assist healthcare professionals in clinical decision making and in the interpretation of patient medical data [11].

The technology and clinical knowledge are available, but in our country their paths have not yet crossed. Our duty is to promote their adoption to advance towards a safer and higher-quality care of cancer patients.

[1] Smith, A. L., Ruiz, I., & Jirón, M. (2014). Errores de medicación en el servicio de medicina de un hospital de alta complejidad. Revista médica de Chile, 142(1), 40-47.

[2] Curilén, N. et al. (2016) Detección, evaluación y caracterización de errores de medicación en pacientes pediátricos de la unidad de paciente crítico de un hospital pediátrico de alta complejidad. 56 Congreso Chileno de Pediatría: Santiago de Chile.

[3] Curilén, N. et al. (2016) Detección, evaluación y caracterización de errores de medicación en pacientes pediátricos del servicio de lactantes de un hospital pediátrico de alta complejidad. 56 Congreso Chileno de Pediatría: Santiago de Chile.

[4] Ranchon, F., Salles, G., Späth, H. M., Schwiertz, V., Vantard, N., Parat, S., … & Dussart, C. (2011). Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs. BMC cancer, 11(1), 478.

[5] Rahimi, R., Kazemi, A., Moghaddasi, H., Rafsanjani, K. A., & Bahoush, G. (2018). Specifications of computerized provider order entry and clinical decision support systems for cancer patients undergoing chemotherapy: a systematic review. Chemotherapy, 63, 162-171.

[6] Elsaid, K. A., Garguilo, S., & Collins, C. M. (2015). Chemotherapy e-prescribing: opportunities and challenges. Integrated pharmacy research & practice, 4, 39.

[7] Sanchez Cuervo, M., Rojo Sanchis, A., Pueyo Lopez, C., Gomez de Salazar Lopez de Silanes, E., Gramage Caro, T., & Bermejo Vicedo, T. (2015). The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation. Journal of clinical pharmacy and therapeutics, 40(5), 550-554.

[8] Aziz, M. T., Ur-Rehman, T., Qureshi, S., & Bukhari, N. I. (2015). Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems. Health Information Management Journal, 44(3), 13-22.

[9] Meisenberg, B. R., Wright, R. R., & Brady-Copertino, C. J. (2013). Reduction in chemotherapy order errors with computerized physician order entry. Journal of oncology practice, 10(1), e5-e9.

[10] Elsaid K, Truong T, Monckeberg M, McCar- thy H, Butera J, Collins C: Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis. Int J Qual Health Care 2013;25:656–663.

[11] Shortliffe, E. H. (1987). Computer programs to support clinical decision making. Jama, 258(1), 61-66.