Errors in giving chemotherapy and associated medicines were found in over seven percent of adult outpatient visits and nearly twenty percent of children’s visits in a recent study. Most often, mistakes were made when changes were made to the original prescription on the day chemo was administered. For children, about a third of mistakes happened when medicines were given at home.
Over nine months and nearly 1,400 visits, researchers found 112 medication errors. Sixty-four of them had a the potential to harm the patient, and 15 actually did. About 5 percent of the time, someone discovered the mistake before the medicine was actually given.
Researchers reviewed charts in four different community outpatient practices in different areas of the United States. They looked for medication errors made in ordering, dispensing, administering, or monitoring drugs given to chemotherapy patients. During the time covered by the study, 11,908 different medicines were given.
More than half (56 percent) of errors were made at the point of chemotherapy administration, about a third (36 percent) were due to wrong prescriptions. Twenty percent were related to medicines used at home, most frequently in children.
The research team physicians reviewing the study information suggested interventions that might have avoided the errors including:
- Writing orders on the day of administration after laboratory results are known
- Improved communication
- Bar coding
- For pediatric patients: double-checking, improved communication, and better instructions for parents in giving medicines at home
The outpatient clinic that used complete electronic medical records to computerize chemotherapy orders had the least administration errors. Only one was found during 500 visits covered by the study.
At the conclusion of their study, Dr. Kathleen Walsh and her colleagues wrote,
As cancer care continues to shift from the hospital to the outpatient setting, the complexity of outpatient cancer care is growing, with increasing opportunities for medication errors, particularly in the home setting. Although national attention has focused for more than a decade on preventing inpatient chemotherapy errors, far less attention has been placed on medication errors that put patients with cancer at risk in the clinic and home settings. The findings of our study may help to reframe medication safety priorities for patients with cancer and suggest some practical targets for intervention to improve the care of both adults and children.
SOURCE: Walsh et al., Journal of Clinical Oncology, JCO Early Release, December 29, 2008.