MOSAIQ’s paperless chemotherapy workflow enhances patient safety

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New Zealand clinic nears second successful year of e-Prescribing

  • MOSAIQ e-Prescribing reduces the chance of human error
  • The Regional Cancer Treatment Service encompasses 50,000 square miles, with a population base of 555,000
  • First inpatient unit rolls out MOSAIQ e-Prescribing

With approximately 3,500 patient interactions annually, Palmerston North Hospital’s 10-chair outpatient chemotherapy clinic, part of the Regional Cancer Treatment Service (RCTS), will mark its second year of MOSAIQ® e-Prescribing in March 2018. The move from paper-based prescribing to a fully electronic system was an effort to improve patient safety by reducing the potential for mistakes, according to Erin Snaith, charge nurse at RCTS.

“Having MOSAIQ calculate doses is safer,” she says. “In the paper-based system we previously used, there was a great deal of transcribing, faxing, scanning and emailing. With MOSAIQ e-Prescribing, the pharmacy is integrated and communicates with the outpatient unit, so the whole process is on one system – there are no pieces of paper flying around the department.

“The physician can see that the prescription has been transmitted to the pharmacy, and can see if it has been prepared or not,” Snaith adds, “and if they want to change the dose they can do it, versus having to email or make a verbal order, which can introduce errors into the process. There is simply a lot more clarity about what is happening with the prescription and a record of why it’s changed, because MOSAIQ asks for it. It’s all about safety.”

The electronic “chain of custody” for prescriptions eliminates dated technology such as the fax machine.

“Fax connections didn’t always go through and sometimes there were poor reproductions on the fax paper that could be incorrectly read, or someone will actually forget to send the fax in the first place.”

Erin Snaith, charge nurse at RCTS, with patient.

In the MOSAIQ e-Prescribing workflow, the potential for dosage-related errors is significantly reduced, as the Oncology Information System (OIS) is equipped with a drug database and alerts for possible harmful drug interactions, she observes.

“In the past, we relied on manual checking to know if a dose was incorrect for a particular chemotherapy drug,” she relates. “For example, if a doctor specified 1,000 mg and the pharmacist concurred and the nurse didn’t question it, then the patient would get 1,000 mg. With MOSAIQ e-Prescribing, if the clinician indicates 1,000 mg, MOSAIQ might provide an alert saying that – based on the MOSAIQ drug database and the OIS’s calculation of body surface area – the dose should not exceed 800 mg for this patient. There’s instant feedback. Again, it goes back to eliminating error.”

Approaching their second year of e-Prescribing at Palmerston North, the staff have grown to greatly appreciate the electronic system, according to Snaith.

“The staff satisfaction is really high,” she says. “They love being able to see everything at a glance instead of having to look on MOSAIQ for the notes and then going and finding the pieces for paper for the chemotherapy. They love having everything on one system.

“I have to emphasize that it’s not as though we overhauled our workflow,” Snaith continues. “It’s just that the workflow is much more visible with the pharmacy electronically linked. So you can see as soon as the doctor inputs a prescription, instead of waiting to find a piece of paper in the box. Any authorized person can access it from a workstation and you don’t have to run up to the day ward to find it – it’s a ‘one-stop-shop’ for the whole patient record.”

On the horizon for 2018 is a plan to roll out MOSAIQ e-Prescribing to the RCTS outpatient chemotherapy clinics in Taranaki and Hawke’s Bay.

Epilogue: Palmerston North’s inpatient clinic goes live with MOSAIQ e-Prescribing

The inpatient chemotherapy unit at Palmerston North Hospital began using MOSAIQ e-Prescribing for a few of the least complex protocols, such as its cisplatin-based regimes and a few simpler hematology regimes.

“Things are going fairly well,” she says. We have taken the opportunity to examine our chemotherapy regimes and simplify them somewhat to maximize the prospects for success with MOSAIQ e-Prescribing. It relies on good communication and handover between the nurses. We’re still on a learning curve with the system, but I can report that the staff are finding it both challenging and exciting and I think most of the nurses enjoy using it. They’re keen to see who’s got the patients with the electronic prescriptions, because they all want to have a turn.”


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