NEW ORLEANS—The use of standardized pediatric chemotherapy forms can improve safety by creating a consistent and streamlined method of ordering Children’s Oncology Group (COG) trial protocols and regimens, according to investigators from Memorial Regional Hospital and Joe DiMaggio Children’s Hospital in Hollywood, Florida.
Wayne R. Shipman, RPh, and Maribeth Arzola, PharmD, showcased the order set they developed for this purpose. It consists of a preprinted chemotherapy ordering form, preprinted medication administration record, and preprinted pharmacy dispensing record that correspond to the 14 COG treatment protocols they use. The forms reflect the protocol for a complete plan of care, they noted.
“Prior to the introduction of our standardized pediatric order sets, we encountered many mistakes in pediatric chemotherapy orders, and these required multiple pharmacy interventions. After the introduction of the preprinted forms, there was a 93% reduction in chemotherapy transcribing and calculations errors,” Arzola said.
These errors were mostly illegible or confusing orders; wrong dosing; and crossed out, altered, or incomplete orders, she explained.
“We decided to revamp the process,” she said. “We redid how we order chemotherapy, dispense chemotherapy, and check chemotherapy on the medication administration record.”
A multidisciplinary team (Chemotherapy Safe Practice Committee) and the oncology pharmacy team created the templates.
The standardized order set consists of a COG protocol template (per tumor site) for chemotherapy orders with a medication dose calculator, which requires two physician signatures; a medication administration record per COG protocol; and a pharmacy triplecheck form, which reflects the COG protocol template and enables the pharmacist to interpret and verify the patient’s plan of care.
The system is not perfect, they acknowledged. Second signatures are sometimes missing, heights and weights may be inconsistent between the order forms, incomplete forms are still sent to the pharmacy, reasons for dose modifications are sometimes lacking, and “crossing out” doses is still an issue.
But the order set has greatly improved accuracy in writing, checking, interpreting, and entering chemotherapy orders; has decreased pharmacy chemotherapy preparation turnaround times; has increased nursing chemotherapy administration efficiency; and has shortened length of stay and throughput times for pediatric patients and their families.