Aims
Cytotoxic chemotherapy has a narrow therapeutic index, and prescribing errors compromise efficacy and safety. In our gynecologic oncology service, the legacy pre-printed order (non-standardized, in use >20 years) was associated with guideline-discordant supportive care, cumulative-dose exceedance of high-risk agents, and a high error burden (annual mean chemotherapy-related problems 24.16±6.05% of prescriptions, 2017–2021; 76.2% attributable to the legacy order). We aimed to develop a standardized, evidence-based pre-printed order to improve guideline concordance and reduce medication errors.
Methods
We conducted a single-centre, pre–post quasi-experimental quality improvement study at a super-tertiary hospital. A multidisciplinary team (oncologists, pharmacists, nurses) redesigned the order based on international guidelines, incorporating checklist-based premedication and discharge medications, regimen-specific referenced templates, mandatory cumulative-dose fields (doxorubicin, etoposide, bleomycin), optimized antiemetic prophylaxis, and shortened infusion times. No accrual target was set; all consecutive prescriptions were included pre-implementation (1 January–31 May 2022; n=4,047) and post-implementation (1 June–31 October 2022; n=3,800). Medication errors identified through routine pharmacist review were classified by process stage.
Results
Guideline-concordant treatment increased from 65.6% to 99.1% (+33.5 percentage points, 95% CI 32.0–35.0), correct antiemetic prophylaxis from 42.1% to 98.2% (+56.1, 95% CI 54.5–57.7), and CINV severity ≤grade 1 from 78.2% to 92.1% (all p<0.001). All error categories fell: prescribing 22.6% to 4.2% (−18.4, 95% CI −19.8 to −17.0), preparation 34.8% to 2.1%, dispensing 6.3% to 2.3% (all p<0.001). Cumulative-dose exceedance was eliminated (1.3% to 0%, p=0.02). Preparation time decreased 32.1% (8.0±5.2 to 5.4±1.1 minutes, p=0.01); staff satisfaction rose from 73% (22/30) to 97% (29/30) (p=0.01).
Conclusions
A multidisciplinary, standardised pre-printed order improved guideline concordance, antiemetic appropriateness, and workflow efficiency while markedly reducing medication errors and eliminating cumulative-dose exceedance. Despite the single-centre pre–post design, this low-cost intervention is readily transferable to other oncology settings seeking safer chemotherapy.