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Primum Non Nocere
Arch Pediatr Adolesc Med. 2006;160:1185.
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Kim et al1 demonstrated that in the practice of pediatric oncology, computerized physician order entry (CPOE) reduced improper dosing, missing cumulative doses, and incomplete nursing checklists. In contrast to these benefits, however, CPOE also resulted in a 5-fold increase in "not matching medication orders to treatment plans." Although little detail was provided on the nature of these medication order/treatment plan "mismatches," it implies that chemotherapy ordered through CPOE deviated more often from intended protocol therapy as compared with paper-ordered chemotherapy. While CPOE ostensibly led to more precise chemotherapy dosing, it increased the risk of that chemotherapy being the wrong chemotherapy.
Increasing the risk of protocol deviation in pediatric oncology has both individual patient and nationwide/study ramifications. For the individual patient, receiving protocol therapy in an unintended way has the potential to cause harm either by overtreament or undertreatment. For patients having data submitted for national study purposes, variability in protocol . . . [Full Text of this Article] AUTHOR INFORMATION
David Dickens, MD;
Dianne Sinsabaugh, RPh;
Brenda Winger, PharmD
RELATED LETTER
Primum Non Nocere—Reply
George R. Kim, Allen R. Chen, Robert J. Arceci, and Christoph U. Lehmann
Arch Pediatr Adolesc Med. 2006;160(11):1185-1186.
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RELATED ARTICLE
Error Reduction in Pediatric Chemotherapy: Computerized Order Entry and Failure Modes and Effects Analysis
George R. Kim, Allen R. Chen, Robert J. Arceci, Sandra H. Mitchell, K. Michelle Kokoszka, Denise Daniel, and Christoph U. Lehmann
Arch Pediatr Adolesc Med. 2006;160(5):495-498.
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