Purpose: A VISN initiative in 2015 led to development of hematology/oncology medication order sets to improve the translation of medication orders from CPRS provider order entry program to pharmacy verification program in VistA. Our purpose is to report the incidence of averted errors due to hematology/oncology medication order translation issues prior to order set initiative as compared to incidence post-order set initiative.
Background: Hematology/oncology medication orders at this outpatient VA oncology clinic are prescribed via provider order entry within CPRS. Safety concerns existed due to inefficient communication between CPRS order entry and pharmacy verification within VistA. A pharmacist verifying orders within VistA was required to re-enter critical medication order information such as drug dose into VistA. In order to find the dose ordered by a provider, the verification pharmacist
advanced at least one screen in VistA then returned to the original VistA verification screen to enter drug dose.
Methods: Incidence of averted errors related to hematology/oncology medication order translation issues between CPRS and VistA are reported for the 2-year time period (October 2013 through September 2015) prior to order set initiative and for the 2-year time period (October 2015 through September 2017) after beginning the order set initiative. Additional information includes facility resources, such as: treatment area, providers, staffing, oncology pharmacy, pharmacy ADPAC, and CACs; mechanisms of orders and notes entering/recording; dosing and safety checks;
and available order sets.
Results: The incidence rate of averted errors related to hematology/oncology medication order translation issues prior to order set initiative was 0.379% as compared to 0.128% rate of averted errors in the two years post order set initiative. Results showed hematology/oncology medication order sets used at this facility positively impacted the incidence of averted errors attributed to translation issues from CPRS to VistA. With fewer averted errors, patient safety increased.
Implications: Using limited VA resources, order sets were implemented for use at this VA outpatient oncology clinic. The hematology/oncology health care team worked together to provide vigilant oversight of order sets and to incorporate necessary revisions, updates, and additions. With fewer averted errors, the effectiveness of this initiative is quantified with improved patient care, safety and efficiency.
