A 'culture of safety'
The Institute's interest in developing health information technology was spurred by a tragedy in 1994, when breast cancer patient and Boston Globe writer Betsy Lehman died, and another patient was injured, from accidental drug overdoses here.
After a painful self-assessment, Dana-Farber began shaping a culture of safety by recognizing that, in the words of national patient safety expert Lucian Leape, MD, medical errors can be reduced by improving the systems behind them. The Institute took such steps as requiring extra checks and approvals for highdose chemotherapy, expanding patient- and family-centered care, physically distancing drugs in the pharmacy from others with similar looks or names, and reducing reliance on handwriting.
With technology helping to create safe systems, Dana-Farber's medication error rate is low today. A recent study in the journal Cancer showed that only about 3 percent of chemotherapy orders in the Institute's three clinics studied contained mistakes. Nurses and pharmacists intercepted most of them before they reached patients, and none caused harm.
"We have a very safe system, but there are still many opportunities for learning and improvement."
— Saul Weingart, MD, PhD
"We have studied medication safety in many organizations and settings, and the error rates we found in the Dana-Farber study were remarkably low, especially given the level of care involved," says David Bates, MD, MSc, of Brigham and Women's and Partners HealthCare System, a consortium of institutions with which Dana-Farber has a joint venture. Bates was an early champion of using information science, a field now known as "informatics," to improve patient care and safety.
While many general hospitals began computerizing the way medications were ordered and health information was stored before Dana-Farber did, oncology presents extra challenges for this type of work: Patient records are often complex and multi-institutional, and when it comes to ordering drugs, the stakes are high. "We have a very safe system, but there are still many opportunities for learning and improvement," says the Institute's Saul Weingart, MD, PhD, vice president for patient safety.
Still, in the cancer world, Dana-Farber is a known leader for patient care informatics. One reason is the interest and resolve of its chief medical officer, Lawrence Shulman, MD, a national speaker on the subject. Shulman, who co-leads Dana-Farber's information technologies project (with Scott MacLean and Naomi Mathis of Information Systems) through a $2 million, three-year grant from Partners, credits the Institute's emphasis on collaboration. "Teams of IS experts and clinicians worked together on different projects and to this day continue to suggest and implement refinements," Shulman says. "It's like building blocks: one piece at a time. We keep making them better, year after year."
