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. 2020 Dec;9(23):8844-8851.
doi: 10.1002/cam4.3496. Epub 2020 Oct 1.

Computer-based simulation to reduce EHR-related chemotherapy ordering errors

Kirk D Wyatt  1 , Elizabeth B Freedman  2 , Grace M Arteaga  3 , Vilmarie Rodriguez  1 , Deepti M Warad  1
Affiliations

Computer-based simulation to reduce EHR-related chemotherapy ordering errors

Kirk D Wyatt et al. Cancer Med. 2020 Dec.

Abstract

Background: The electronic health record (EHR) is a contributor to serious patient harm occurring within a sociotechnical system. Chemotherapy ordering is a high-risk task due to the complex nature of ordering workflows and potential detrimental effects if wrong chemotherapeutic doses are administered. Many chemotherapy ordering errors cannot be mitigated through systems-based changes due to the limited extent to which individual institutions are able to customize proprietary EHR software. We hypothesized that simulation-based training could improve providers' ability to identify and mitigate common chemotherapy ordering errors.

Methods: Pediatric hematology/oncology providers voluntarily participated in simulations using an EHR testing ("Playground") environment. The number of safety risks identified and mitigated by each provider at baseline was recorded. Risks were reviewed one-on-one after initial simulations and at a group "lunch-and-learn" session. At three-month follow-up, repeat simulations assessed for improvements in error identification and mitigation, and providers were surveyed about prevention of real-life safety events.

Results: The 8 participating providers identified and mitigated an average of 5.5 out of 10 safety risks during the initial simulation, compared 7.4 safety risks at the follow up simulation (p=0.030). Two of the providers (25%) reported preventing at least one real-world patient safety event in the clinical setting as a result of the initial training session.

Conclusions: Simulation-based training may reduce providers' susceptibility to chemotherapy ordering safety vulnerabilities within the EHR. This approach may be used when systems-based EHR improvements are not feasible due to limited ability to customize local instances of proprietary EHR software.

Keywords: electronic health records; high fidelity simulation training; medical informatics; patient harm; patient safety; simulation training.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Provider identification and mitigation of errors during initial and follow‐up simulation assessments (n = 8)
See this image and copyright information in PMC

References

    1. Institute of Medicine Committee on Patient Safety and Health Information Technology . Health IT and patient safety: building safer systems for better care. Washington, DC; 2011. - PubMed
    1. Kim GR, Chen AR, Arceci RJ, et al. Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis. Arch Pediatr Adolesc Med. 2006;160(5):495–498. - PubMed
    1. Mertens WC, Christov SC, Avrunin GS, et al. Using process elicitation and validation to understand and improve chemotherapy ordering and delivery. Jt Comm J Qual Patient Saf. 2012;38(11):497–505. - PubMed
    1. Institute of Medicine Committee on Quality of Health Care in America . Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: National Academies Press; 2000. - PubMed
    1. Issenberg SB, Chung HS, Devine LA. Patient safety training simulations based on competency criteria of the Accreditation Council for Graduate Medical Education. Mt Sinai J Med. 2011;78(6):842–853. - PubMed

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