Authors (including presenting author) :
Chan TY(1), Wong KM(1), Fong SK(2), Chan CC(2)
Affiliation :
(1)Department of Pharmacy, Queen Elizabeth Hospital, (2)Department of Medicine, Queen Elizabeth Hospital
Introduction :
Standardised computer-generated chemotherapy order form is a preventive measure from chemotherapy associated medication error. Queen Elizabeth Hospital has been using Medication Administration Record (MAR) on no-carbon-required (NCR) papers for prescribing chemotherapy and a chemotherapy regimen sheet was required for each cycle which increased prescribing time and could cause discrepancies in prescribing. As a medication safety measure, pharmacy collaborated with the Medical Haematology team to develop a new set of ‘Chemotherapy Administration Record’ (CAR). The new CAR includes pre-medications and supportive medications associated with the chemotherapy regimen and a regimen-specific administration chart. The use of the chemotherapy regimen sheet was eliminated.
Objectives :
This study aims to assess the impact of introducing a new prescription form to the haematology unit in terms of medication safety followed by the acceptance of the new CAR by the medical and nursing staffs.
Methodology :
A one-month pre-implementation study was conducted before the implementation of CAR and a three-month post-implementation study was conducted after the implementation. Data was collected by nurses and pharmacists respectively on clarifications made with the prescribing physician and interventions made for each prescription. After the implementation, an impact survey was distributed to each haematologists and nurses in the haematology ward to collect their views on medication safety and workload to assess the acceptance of the new CAR.
Result & Outcome :
Among the prescriptions reported by nurses, the rate of prescriptions which required further clarification with the prescribing physician before proceeding to drug preparation reduced from 52.2% to 17.3%, within which prescriptions with incomplete information reduced from 32% to 13.5%. Prescriptions with discrepancies between the MAR and chemotherapy regimen sheet were eliminated. Among prescriptions reported by pharmacists, the rate of prescriptions which required clarification reduced from 50% to 22.4%. The percentages of prescriptions with missing information were reduced from 34.3% to 16.4%. The reductions were statistically significant (p<0.001and p=0.001). Positive responses were received from the impact survey and the new ordering forms are well accepted by the haematology unit.
The new CAR can facilitate drug prescribing by eliminating the use of chemotherapy regimen sheet and facilitate drug administration by including a regimen-specific administration chart for each regimen. It can also improve medication safety by promoting the completeness of prescriptions.
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