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Ten years on, has e-prescribing of cancer regimens improved safety?

By Fiona McCarthy, MBChB, MRCP, Saadhiya Hussain, DipGPP, MRPharmS, Christopher Watson, DipGPP, MRPharmS, Melissa Phillips, MBBS, MRCP, and C J Gallagher, PhD, FRCP


Clinician using a computer


To assess whether or not introduction of an electronic system for prescribing cancer regimens improved patient safety.



This prospective study was carried out at St Bartholomew’s Hospital, London, over a seven-week period. A data collection tool was used by oncology pharmacists to document any prescribing errors identified. All errors were reviewed by a specialist registrar and an oncology pharmacist, who classified actual and potential errors according to their clinical severities. These results were compared with a previous audit of paper-based chemotherapy prescribing.


Over the study period 1,426 chemotherapy prescriptions were reviewed and 89 (6.25%) prescribing errors were identified. There were 42 (2.95%) minor errors, 40 (2.8%) moderate errors and seven (0.49%) severe errors. All errors were identified before the drugs were administered to patients. Compared with our previous audit of paper-based prescriptions, there was a 10-fold reduction in errors. 


Medication errors arise when there is a breakdown in the multiple steps of drug delivery. A formal system of prescriber training and accreditation with the implementation of electronic prescribing produced a significant reduction in prescribing errors, thereby improving patient safety. 



Prescribing chemotherapeutic medicines has the potential for serious error and patient harm. In recent years, there have been several widely reported cases where incorrect administration or doses of chemotherapy have resulted in patient death. Anecdotally, many errors are attributed to illegible prescriptions, as well as to a lack of adequate documentation.

The 2008 UK National Confidential Enquiry into Patient Outcome and Death report “For better, for worse?” reviewed the care of patients who died within 30 days of receiving chemotherapy. Authors of the report issued recommendations to improve overall patient care and safety, one of which was that electronic cytotoxic prescribing should be introduced to reduce the considerable risk to patient safety posed by handwritten prescriptions.

At present, all oral and intravenous chemotherapy at St Bartholomew’s Hospital in London is prescribed using the ARIA software system. This was introduced in 2007, before which time chemotherapy prescribing was done on handwritten prescriptions.

We carried out a prospective audit reviewing all electronically generated chemotherapy prescriptions over a seven-week period. The number and types of errors were then compared with a similar audit carried out at the hospital in 2000 (before the introduction of electronic prescribing).

Overall, we found that the introduction of electronic prescribing significantly reduced the number of errors compared with handwritten prescriptions. The number of severe errors also decreased significantly.

We believe that the implementation of electronic prescribing is a practical approach to improve patient safety and outcomes and we encourage all chemotherapy units to introduce such a system.


Fiona McCarthy is specialist registrar for medical oncology, Saadhiya Hussain is specialist oncology pharmacist, Christopher Watson is specialist oncology pharmacist, Melissa Phillips is specialist registrar for medical oncology and C J Gallagher is consultant medical oncologist, all at Barts Health NHS Trust.



Citation: Clinical Pharmacist URI: 11110039

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