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Journal de Pharmacie Clinique

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Computerized prescribing of standardized chemotherapy schedules: residual medication errors and pharmaceutical interventions. Volume 25, issue 1, Janvier-Février-Mars 2006

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Authors
Département pharmaceutique, CHU de Besançon, Service d’oncologie médicale, CHU de Besançon, Service d’hématologie clinique, CHU de Besançon, Inserm U645, Besançon, Inserm EPI 106, Dijon

Computerized prescribing allows to prevent medication errors, especially in cancer patients. The objective of this prospective study was to assess the residual risk of errors related to a computerized prescription of chemotherapy, based on standardized schedules. The relevance of pharmaceutical interventions was also studied. The study was carried out in Besançon University Hospital. All consecutive chemotherapy (protocols) prescribed from January 1 st to June 30 th, 2005 were included. Pharmaceutical analysis was performed (pharmacist or resident) using a standardized process. Pharmaceutical interventions were collected prospectively, and their consequences were analyzed. The clinical impact of each modification related to a pharmaceutical intervention was scored using a validated scale. During the study period, 4,314 consecutive prescriptions (796 patients) were analyzed. A pharmaceutical intervention was performed in 138 cases (3.2%). More than half of these (52.9%) resulted in a modification of the initial prescription. Forty-four (60%) interventions were considered to have a significant clinical impact. A potentially fatal event was avoided in 4 cases. The pharmaceutical interventions were mainly in relation with prescribed dosages. Our study showed the effectiveness of the computerization and the standardization of chemotherapy prescribing. Nevertheless, a residual risk of medication error was identified. Pharmaceutical analysis appeared to be necessary, and potentially tragic events were avoided by interventions. More generally, controlling the risk of medication errors also implies an assessment of the preventive actions taken.