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Cases & Commentaries
- Web M&M
Lydia C. Siegel, MD; Tejal K. Gandhi, MD, MPH; January 2009
Four months after surgery, a woman with osteosarcoma receiving outpatient chemotherapy was admitted for possible cellulitis. Discharged home on methotrexate and antibiotics, the patient developed methotrexate toxicity, partly due to a drug interaction.
Journal Article > Study
Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis.
Elsaid K, Truong T, Monckeberg M, McCarthy H, Butera J, Collins C. Int J Qual Health Care. 2013;25:656-663.
Chemotherapy is a notoriously high-risk medication. A chemotherapy medication prescribing error was responsible for one of the most infamous patient safety cases, the tragic death of Boston Globe reporter Betsy Lehman. Computerized provider order entry is thought to reduce prescribing errors, but it has not specifically been studied for chemotherapy. In this study, implementation of standardized templates for chemotherapy ordering was associated with a significant reduction in prescribing errors as well as administration errors. While this study is promising, a recent AHRQ WebM&M commentary illustrates that even standardized ordering protocols cannot entirely prevent chemotherapy errors.
Journal Article > Study
Murphy DR, Laxmisan A, Reis BA, et al. BMJ Qual Saf. 2014;23:8-16.
Delayed diagnoses in cancer may commonly be caused by cognitive errors or logistical breakdowns. These delays can lead to poor patient outcomes and are a frequent cause of malpractice lawsuits in the ambulatory setting. In this study, four electronic triggers were developed to detect patients at risk for delayed diagnosis of prostate and colorectal cancers. The algorithm identified patients with elevated prostate-specific antigen levels, positive fecal occult blood tests, iron-deficiency anemia, or bright red blood per rectum, but automatically excluded those that already received appropriate care or had known terminal illnesses. The positive predictive values for each these triggers were between 58% and 70%, providing a reasonably accurate report of patients that truly lacked appropriate follow-up. The American Medical Association has identified better follow-up of abnormal test results as a key area for improving patient safety in the ambulatory setting.
Journal Article > Review
Pawloski PA, Brooks GA, Nielsen ME, Olson-Bullis BA. J Natl Compr Canc Netw. 2019;17:331-338.
In this systematic review, researchers sought to evaluate the impact of clinical decision support (CDS) on the quality and safety of care provided to cancer patients. Most of the studies included in the study demonstrated improved outcomes related to the use of CDS, but the authors conclude that more rigorous research regarding the impact of CDS on clinical outcomes for oncology patients is needed.