• 2,300 women
    women were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2015
  • 86%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2016
  • 71%
    of stage III colon cancer patients received chemotherapy within 60 days of after surgery in 2014
  • 86%
    of all cancer surgery patients received their consult within the recommended wait time in 2016, and 87% received their surgery within the recommend wait time
  • Over 43,000
    patients were discussed at comprehensive multidisciplinary cancer conferences (MCCs) in fiscal year 2016/2017
  • About 13%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following surgery
  • 79%
    of breast cancer patients had a guideline-recommended mammogram in the first follow-up year
  • 74%
    of colorectal cancer patients diagnosed in 2013 had a surveillance colonoscopy within 18 months of surgery
  • Over 100
    patient and family advisors, who vary by their type of cancer and experiences, represent diverse regions and work with Cancer Care Ontario to ensure a person-centred cancer system
  • 383,023
    unique patients were screened for symptom severity using Your Symptoms Matter – General Symptoms (YSM-General) in 2016
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Systemic Treatment Safety: Best Practice Drug Ordering

 
Measure Desired Direction As of this Report
Percentage of systemic treatment visits supported by Computerized Prescriber Order Entry. Black Arrow Up Green Arrow Up
See Methodology and Approach to find out how the ratings are calculated.

Key findings

As part of an effort to support the safety of patients receiving complex systemic drug regimens (chemotherapy), the implementation of computerized prescriber drug ordering systems for chemotherapy by hospitals continues to increase. Cancer Care Ontario surpassed its target of 90% in 2014.

What is best practice drug ordering technology?

  • Systemic Treatment Computerized Prescriber Order Entry (ST CPOE) is an electronic application used by clinicians to enter an order for systemic treatment (chemotherapy) for a patient with cancer. One of the ST CPOE systems supported by CCO is the Oncology Patient Information System (OPIS). OPIS is a fully automated drug order entry program. It includes online drug profiles and prompts for potentially adverse drug interactions, and offers real-time electronic communication among physicians, nurses and pharmacists about drug orders and changes in dose.
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What do the results show?

Computerized drug order entry implementation is increasing steadily across the province (Figure 1).

  • Implementation of ST CPOE systems has slowly and consistently increased across the province since 2004. The rate has risen from 45% of systemic (IV chemotherapy) visits being supported by ST CPOE in 2004, to 97% being supported by CPOE in 2015. Data for this measure were collected annually until 2013, and then collected every other year.
  • In 2015, Cancer Care Ontario met its target of 90%, actually reaching 97%.

Why is this important to patient care?

Computerized ordering minimizes errors.

  • Prescription and medication errors can happen at any time—from when a physician writes a prescription, to when a pharmacist verifies and prepares the order or when a nurse verifies the medication and administers it to the patient. A study of adverse drug events conducted by Leape et al (1995)1 showed that 39% of errors occurred in the physician order phase; drug dosing accounted for 28% of all errors1.
  • Drug ordering software that alerts the physician or pharmacist to potential prescribing problems and electronically transmits the order to a pharmacy can prevent prescription and medication errors.
  • Computerized drug ordering systems have been shown to reduce errors for prescribed chemotherapy regimens from 15% to near zero2. They can also decrease medical errors, cut costs, shorten treatment visit times and improve compliance with guidelines3.

Chemotherapy involves complex drug regimens.

  • Electronic drug prescribing is particularly important in cancer care, because chemotherapy consists of complex drug regimens prepared for each patient’s specific stage and type of cancer. For example, if the dosage is too low, the patient will not get the benefits of the treatment; if the dosage is too high, it may be toxic or even fatal.
  • This complexity increases the chance of errors. ST CPOE helps ensure orders are entered accurately and communicated clearly to the pharmacist and the nurse.
  • Features and functionalities exist within ST CPOE systems to reduce prescription and medication errors, particularly in these complex regimens.

CPOE reflects best practices for administering drug orders.

  • The recently released Computerized Prescriber Order Entry (CPOE) for Systemic Treatment: Best Practice Guideline (Guidelines) provides evidence-based recommendations for purchasing, designing and evaluating ST CPOE systems. Guidance includes the key features, functionalities and components of an ST CPOE system that are required to ensure safe, high-quality chemotherapy treatment.
  • The Guidelines were developed by an interdisciplinary panel of physicians, nurses, pharmacists, methodologists, IT specialists and other experts.
  • These Guidelines are designed to enhance patient safety, based on clinical best practice. They are not vendor specific, and they have been developed using existing information and technology standards.
  • To optimize the use of these systems, Cancer Care Ontario will be working with hospitals to better understand how their current systems are compliant with these standards. Cancer Care Ontario is also working to update the Guidelineswith information specific to oral chemotherapy, as this was not specifically addressed in the original document.

Find out more

For more information on the Systemic Treatment Program, visit Cancer Care Ontario’s website.

View Notes

  1. Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995 Jul 5;274(1):35-43.
  2. Kukreti V, Cosby R, Cheung A, Lankshear S, ST Computerized Prescriber Order Entry Guideline Development Group. 2014. Computerized prescriber order entry in the outpatient oncology setting: from evidence to meaningful use. Current Oncology. 21(4): e604.
  3. Kuperman GJ and Gibson RF. 2003. Computer physician order entry: benefits, costs, and issues. Annals of Internal Medicine. 139(1): 31–39.