Drug Errors Common in Chemo Treatments

Drug Errors Common in Chemo Treatments
Improved Communication May Be Best Method to Prevent Mistakes
By Bill Hendrick

Reviewed by Brunilda Nazario, MD

Jan. 1, 2009 -- A new study shows that medication errors are common among children and adults taking chemotherapy drugs at home or in outpatient clinics.

Researchers reviewed records of nearly 1,300 patient visits at three adult oncology outpatient clinics and 117 patient visits at one pediatric facility between Sept. 1, 2005, and May 31, 2006.

They showed that 7% of adults and 19% of children taking chemotherapy drugs in outpatient clinics or at home were given the wrong dose or experienced other medication mistakes.

The study, published in the Journal of Clinical Oncology, calls for improved communication to cut down on errors it describes as "high" in adult and pediatric cancer patients.

Of the errors involving adults, 55 had the potential to harm the patient, and in 11 instances, harm was caused, the researchers say.

About 40% of the medication errors in children had the potential to cause harm, and four children actually were harmed by mistakes, the study shows.

In a news release, Kathleen E. Walsh, MD, assistant professor of pediatrics at the University of Massachusetts Medical School, says that as cancer care increasingly shifts to outpatient settings, the potential for errors goes up correspondingly.

More than 70% of errors in children occurred at home, says Walsh, the study's leader.

Examples of pediatric errors included giving the wrong amount of medication or giving it at the wrong frequency because of confusion about instructions.

The mistakes in adults included the administration of incorrect doses because of confusion over conflicting orders. Consequences of mistakes included patients being overhydrated prior to giving chemotherapy and abdominal pain in patients taking narcotics without treatment for constipation.

The researchers say more than 50% of errors involving adults were in clinic administration, 28% in ordering medications, and 7% in use of chemo in patients' homes.
Why Medication Mistakes Happen

"As cancer care shifts from the hospital to the outpatient setting, adults and children with cancer receive more complicated, potentially toxic medication regiments in the clinic and home," Walsh and colleagues write in the article.

According to the researchers, methods to prevent outpatient medication mistakes often fail because of a lack of recognition of errors, communication problems, and fragmentation of care.

Chemotherapy regimens outside of clinical settings are "particularly complex because of the intense monitoring required" and a plethora of potential problems made more likely when drugs are taken in a non-clinical setting, they write.
Preventing Medication Errors

"Information technology such as computer order entry, electronic medication administration records and bar-coding used to prevent errors in the inpatient setting may be particularly important in outpatient clinics where multiple oral and intravenous medications are administered, such as in an oncology clinic," the researchers contend.

One simple strategy to reduce errors: requiring that medication orders not be written until the day of administration, the researchers suggest.

Walsh says in the release that most errors involving children could be reduced "by better communication and support for parents of children who use chemotherapy medications at home."
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SOURCES:

News release, University of Massachusetts Medical School.

Walsh, K. Journal of Clinical Oncology, published online ahead of print Dec. 29, 2008.