Dateline DFCI
Three online projects enhance pediatric cancer care
In an effort to enhance patient safety, Dana-Farber and Children's Hospital Boston have joined together to improve the way pediatric chemotherapy orders are placed, and patient information is tracked by both hospitals.
Amy Billett, MD (at computer), watches the new medication order-entry system go "live" in March with colleagues from Children's Hospital Boston.
This past spring, teams from DFCI and Children's rolled out a computerized order-entry system for patients in the Jimmy Fund Clinic and the oncology unit at Children's that is flexible, logical, and protects against errors. It resembles a model already in place for adult oncology patients at Dana-Farber and Brigham and Women's Hospital, but it also offers features to meet children's unique needs — including the ability to order all medications and fluids (not just chemotherapy) based on the size of the patient.
The pediatric system emerged from a year-and-a-half-long effort involving more than 70 staff members. It guides doctors through the medicationordering process with a series of screens for prescribing the type and amount of chemotherapy and fluids patients should receive, the schedule for giving them, and the conditions under which they should be administered or dispensed. Nursing orders are placed through the new program as well.
"If we enter anything out of the ordinary, the computer requires us to type in why," explains Amy Billett, MD, of Dana-Farber's Pediatric Oncology Department. "The program makes you enter the right thing, but it also makes it easy to enter the right thing. The system is very intuitive."
To enable the project to work, staff were compelled to create a "crosswalk" linking the computer registration systems at Children's, where inpatient services for children with cancer are provided, and Dana-Farber, which delivers outpatient services. The crosswalk allows patients' registration numbers from both hospitals to appear on medication orders so that orders are matched correctly with patients. A computer work station that enables staff to access the DFCI and Children's systems from one computer was also developed.
The crosswalk system and new work station represent a marked improvement over the past when the two hospitals' computer systems did not communicate.
"These three online projects drew on the talents of people at both Dana-Farber and Children's — computer applications and networking specialists, physicians, nurses, pharmacists, security, quality control, and more," attests Billett. Adds Kathy Vitale, RN, MS, of Children's, "Their cooperation resulted in systems that will provide major benefits to both institutions."
