Chemotherapy Dose Limits Set by Users of a Computer Order Entry System

Abstract

Objective

The elimination of dosing errors related to chemotherapy administration remains an elusive goal. Computerized order entry reduces errors but is not widely used. One problem in implementing computer dose checking is the lack of standardized dose limits. We evaluated the dose limits set for chemotherapeutic agents by users of a computer order entry system.

Methods

Oncology practices from 82 sites using a computer order entry system submitted data via the Web to a central data warehouse on 280,047 drug administrations for 16,976 patients. Data were blinded to patient and site but included the diagnosis, age, chemotherapy regimens, dosages, and dose adjustments. Dose limits, set by users at each location, were assessed. For commonly used regimens, the range of customary doses was also assessed.

Results

The mean dose limit was less than that for a body surface area (BSA) of 2.2 meter squared in 43/44 (98%) of the drugs dosed according to BSA. This user set dose limit was exceeded in only 3% of drug administrations.

Conclusion

In setting computerized dose limits, most oncologists use a dose limit below that for a BSA of 2.2 meters squared. This user set limiting dose was rarely exceeded, with 97% of dosages below the limits set in this computer order entry system.