Potential benefits and problems with computerized prescriber order entry: Analysis of a voluntary medication error-reporting database

2006 ◽  
Vol 63 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Chunliu Zhan ◽  
Rodney W. Hicks ◽  
Christopher M. Blanchette ◽  
Margaret A. Keyes ◽  
Diane D. Cousins
Keyword(s):  
Medication Error ◽  
Error Reporting ◽  
Order Entry ◽  
Medication Error Reporting ◽  
Potential Benefits ◽  
Computerized Prescriber Order Entry

Description of the role of pharmacist independent double checks during cognitive order verification of outpatient parenteral anti-cancer therapy

2021 ◽  
pp. 107815522199431
Author(s):  
Jennifer P Booth ◽  
Julie M Kennerly-Shah ◽  
Amber D Hartman
Keyword(s):  
Cancer Therapy ◽  
Medication Error ◽  
Retrospective Analysis ◽  
Error Reporting ◽  
Single Center ◽  
Medication Error Reporting ◽  
Anti Cancer ◽  
Secondary Endpoints ◽  
Type Frequency

Introduction To describe pharmacist interventions as a result of an independent double check during cognitive order verification of outpatient parenteral anti-cancer therapy. Methods A single-center, retrospective analysis of all individual orders for outpatient, parenteral anti-cancer agents within a hematology/oncology infusion center during a 30 day period was conducted. The primary endpoint was error identification rates during first and second verification. Secondary endpoints included the type, frequency, and severity of errors identified during second verification using a modified National Coordinating Council for Medication Error Reporting and Prevention Index. Results A total of 1970 anti-cancer parenteral orders were screened, from which 1645 received an independent double check and were included. The number of errors identified during first and second verification were 30 (1.8%) and 10 (0.6%) respectively; second verification resulted in a 33.3% increase in corrected errors. The 10 errors identified during second verification included: four rate transcriptions to optimize pump interoperability, three rate and/or volume modifications, two dosage adjustments, and one treatment deferral due to toxicity. The severity was classified as Category A for four (40%), Category C for three (30%), and Category D for three (30%) errors. This correlated to a low capacity for harm for seven (70%) and a serious capacity for three (30%) errors. Conclusions Second verification of outpatient, parenteral anti-cancer medication orders resulted in a 33.3% increase in corrected errors. Three errors detected during second verification were determined to have a serious capacity for harm, supporting the value of independent double checks during pharmacist cognitive order verification.

Medication Error Reduction: The Pharmacy Technician's Role

1998 ◽  
Vol 14 (2) ◽  
pp. 70-77 ◽  
Author(s):  
Eddie B Dunn ◽  
Jonathan J Wolfe
Keyword(s):  
Public Health ◽  
Medication Error ◽  
Error Reduction ◽  
Error Reporting ◽  
Health Issue ◽  
Public Health Issue ◽  
Pharmacy Technician ◽  
Medication Error Reporting ◽  
The Us ◽  
Coordinating Council

This article presents medication error reduction as a public health issue relevant to the pharmacy technician. The chief types of errors are presented, and opportunities for technicians to identify errors and factors that promote errors are described. The article then discusses the importance of medication error reporting by technicians. Emphasis is placed on the necessity of examining the reason why errors occur rather than assigning blame. The US Pharmacopeia Practitioners' Reporting Network is described in detail, along with the newer National Coordinating Council for Medication Error Reporting and Prevention.

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