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Dispensing Drug Dosage To Children Through Computers

ders to treatment plans was slightly higher with the use of the electronic chemo order system, probably because current versions do not allow users to match a specific drug order to a recommended one, and because new or experimental drugs do not appear on the system's dropdown menu. This shortcoming will be eliminated after a hospital-wide adoption of a new computer provider order entry system in the near future, researchers say.

"One of the important lessons from this study is that machines alone do not prevent errors, and, in fact, may initially introduce new potential hazards," says co-investigator Robert Arceci, M.D., director of pediatric oncology for The Johns Hopkins Kimmel Cancer Center, where more than 200 children receive cancer treatment each year. "It takes a whole culture of safety and vigilance to prevent errors."

However, the tradeoffs of correct dosing, legible orders and adherence to safety procedures all outweigh the negative effects, researchers say.

Because pediatric chemotherapy is such a complex process, it was crucial for researchers to know exactly where mistakes were most likely to occur before they designed the program. To do so, Lehmann and colleagues used a model called failure modes and effects analysis (FMEA), originally developed by the military. FMEA analysis showed researchers what kinds of errors occurred, where they were most likely to occur and what the potential for harm was. The most frequent errors were misidentification of patients and entering incorrect patient information, such as weight and height. Less frequent were dosage miscalculations and dosing errors due to mismatching drug orders to chemotherapy protocols. Lehmann designed the software application in a manner that precision-targeted these areas.

Based on these findings, researchers recommend the adoption of digitized systems for intravenous drug infusions, as well as chemotherapy orders, in high-risk clinical areas, su
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