BD Oncology

Preventing misdosing with automated workflows

Being a nurse who administers chemotherapy to cancer patients is an inherently challenging job. Every dose delivered must fulfil the five rights of medication administration:


Right patient

Right medication

Right dose

Right time

Right documentation


However, the administration process within oncology is often long and complex, and presents numerous opportunities for dosing errors.

Errors that occur due to the incorrect administration of chemotherapy can have serious consequences, not only in regards to having a detrimental effect on the health of a patient, but also by having a negative psychological impact on the staff member involved. Additionally, errors can be costly to an organisation, both due to the financial cost of resolving the error, and the potential damaging effect of it on the hospital’s reputation. Therefore, taking steps to prevent misdosing is key.

We are going to discuss how manual medication workflow processes have the potential for misdosing, and how automating these processes can help reduce the risk.

Potential for error with manual workflows

Some healthcare organisations still use paper files for the recording and transfer of patient data between departments, which are at risk of being misplaced or misinterpreted, whilst information relayed during phone calls can be easily forgotten. The delivery of a chemotherapy treatment regimen at any one administration session can take several hours and can involve more than one nurse, which presents an opportunity for miscommunication if patient data hasn’t been transferred effectively. All these issues can result in a nurse not having the most up-to-date information about the patient and their treatment at the point of administration, which could potentially lead to an error.

Another potential source of error at the point of administration is handwritten prescriptions, resulting in legibility issues. For example, a nurse could administer a medication by an incorrect infusion rate due to misreading a poorly written or illegible prescription.

Stressful working environments for nurses and other staff within oncology can have an influence on human factors related to medication errors. Sutherland’s paper on the subject of human factors in prescribing errors states that “mitigating fatigue and standardising procedures may minimise slips and lapses”.2 Manual workflows that are timeconsuming and rely on visual checking of processes contribute to potential stress and fatigue of healthcare staff.

Misdosing by a nurse can also be a result on an error earlier on in the treatment pathway, such as the medication being incorrectly prescribed by an oncologist, or incorrectly compounded by pharmacy. Following manual workflows for prescribing and compounding have a lot of opportunities for human error. For example, when the oncologist is required to perform dose calculations themselves, or have knowledge and awareness of dose limits and cumulative dose limits of drugs that they must not exceed. Or when, during the compounding process, the pharmacy technician has to visually check that the vial of drug they select is correct, or that the volume of drug drawn up is accurate.

Automating workflows represents an opportunity to address all these potential causes of errors associated with manual workflows.

Automating workflows

Workflow automation can play a huge part in preventing misdosing within oncology. For a nurse, workflow automation can bring clarity and confidence that they are administering medication correctly. Automation can also help streamline processes by eliminating many resource-intensive tasks. This can help reduce the workload on staff, and free up nurse time for direct patient care or other value-added tasks.

BD offers solutions to automate workflows, addressing the challenges that come with paper-based systems and manual verification processes. These solutions include:

  • BD Cato™ - an integrated, automated* software solution that provides support through all stages of intravenous chemotherapy prescribing, preparation and administration.
  • BD Cato™ ReadyMed – a simple and intuitive barcoded medication administration documentation, checking and tracking program used by nurses that helps ensure the correct administration of medication.
  • BD BodyGuard™ Duo - an infusion pump designed to help improve patient safety.

Impact of automation step-by-step

The step-by-step summary below shows the oncology workflow from prescription through to administration, and how the use of automation within this workflow can help prevent misdosing. Points 1-2 relate to oncologist and pharmacy processes, as prevention of errors at this stage offers reassurance to nurses that they are administrating the correct treatment, whilst points 3-4 demonstrate how automation helps to prevent direct administration errors for nurses:

  1. Automation during drug prescribing: The oncologist electronically prescribes chemotherapy on BD Cato™ Prescribe**, reducing the risk of illegibility from handwritten prescriptions. Due to interfacing with hospital information systems, the oncologist is able to align the prescription with the patient’s latest clinical results. Pre-built protocols, automatic dose calculations, and warnings if the dose exceeds the recommended limits helps reduce the risk of prescribing errors.
  2. Automation during compounding: BD Cato™ Pharmacy integrates with barcode scanners and gravimetric scales. Barcode verification of starting materials and gravimetric measuring of volumes drawn up during the compounding process help to ensure the correct preparation of a medication. BD Cato™ Pharmacy prints out a label to be applied to the final product, removing the need for handwritten labels. This label also contains a barcode, which is used for electronic verification prior to administration.
  3. Automation during the nurse checking process: BD Cato™ allows the nurse to view the patient’s up-to-date therapy plan, as any amendments made by the oncologist, or by pharmacy, are updated in the system. Due to interfacing with hospital systems, information such as the patient’s test results are readily available for the nurse to check at the point of administration. BD Cato™ ReadyMed is used to scan the patient’s wristband barcode and the barcode on the medication, allowing the nurse to electronically verify that the 5 rights of medication administration have been fulfilled. If an error is detected, it informs the nurse with a hard-stop, helping to prevent the incorrect medication being administered.
  4. Automation during administration: The nurse can then use the BD BodyGuard™ Duo pump to administer the medication. With 2 infusion channels, a single simplified user interface, and concurrent flow capability, the BD BodyGuard™ Duo infusion system addresses the needs of high intensity multi-channel infusion environments such as out-patient medical oncology.

Demonstrating the impact of automation

Studies have shown the impact of automation using BD solutions on reducing misdosing:

  • One study showed that BD Cato™ Prescribe** reduced prescribing errors by 57% when compared to handwritten prescriptions.4
  • A study across 10 hospitals in Europe reported BD Cato™ Pharmacy detected 7.89% of the 759,060 doses prepared during compounding contained errors that could have caused critical therapy implications during the compounding process. It concluded that these errors were unlikely to have been detected using a manual compounding process alone.3
  • When BD Cato™ ReadyMed was introduced into East Tallin Central Hospital in Estonia in 2019, 80% of oncology nursing staff reported that it reduced the risks associated with intravenous administration errors despite an increase in the number of chemotherapy treatments being delivered at the time.5 It was also estimated that BD Cato™ ReadyMed saved of 3 hours, 24 minutes of nursing time per day due to streamlining the administration process.6

In Summary

Preventing misdoing within oncology is a top priority as it benefits patients, staff, and the organisation. Many dosing errors could be prevented by introducing technology and systems that embed error prevention, rather than relying on manual workflows and checking procedures that have multiple opportunities for human error.

BD’s solutions can help implement automation into the oncology workflow and provide confidence to nurses that they are administering their patients the right medication, at the right dose, at the right time, and by the right route.

Unmisakably BD Oncology.