Prospective drug chart review by pharmacists is an important risk minimisation strategy in the detection and prevention of prescribing medication incidents (PMis). Feedback reporting to the clinical team facilitates learning from and the identification and prevention of system-based PMis. At Westmead Hospital, Sydney, the establishment of a relational database ofprevented-PMis in November 2001 enabled such feedback reporting. Assessment of the reporting process after 12 months indicated review and application of the data within quality frameworks, value in improving prescribing practice and continued interest in receiving the reports. Implementation of feedback reporting has facilitated learning from PMis beyond the prescriber to the team and organisational levels. PMI data have been incorporated into 'safe prescribing' training programs for junior doctors. The proactive role of the clinical pharmacist in ensuring safe medication outcomes has been highlighted. Establishment of data management and reporting processes may assist future incorporation into wider incident-monitoring systems.

A 50-year-old female diagnosed with high-grade infil trating ductal carcinoma of the left breast was planned for insertion of a central venous catheter for a 6-week continuous infusion regimen including weekly ifosfamide/mesna alternating with weekly epi rubicin/vincristine via a CADD portable infusion pump; then radiotherapy followed by a further 6 weeks of VIE infusional chemotherapy. The initial 6 weeks of therapy was complicated by infected central venous catheter during week 2. Central venous catheter was removed and chemother apy was administered peripherally. After completion of XRT, a new central venous catheter was inserted and the second cycle of epirubicin/vincristine chemo therapy was commenced. During week 3 of the second cycle the patient developed right neck pain and swelling, which was diagnosed as a haematoma and cellulitis which was treated with cephalexin. The following week she was admitted for intravenous antibiotics and drainage of the haematoma. Exploration of the neck swelling revealed fat necrosis and extravasation of chemother apy into the subcutaneous tissues. Chemotherapy was stopped, and treatment was commenced for extrava sation of an unknown volume of ifosfamide/mesna administered weeks 1 and 3, and epirubicin/vincris tine administered weeks 2 and 4 for unknown period, possibly 3 weeks. The extravasation was treated as per the institu tional policy for anthracycline extravasation; topical dimethyl sulphoxide and cold packs were applied every six hours for 14 days and plastic surgeons were consulted. Central venous catheter was removed 10 days after detection of the extravasation. Inflamma tion and pain resolved slowly over 4 weeks. The patient has had no further chemotherapy, and re mains in CR. There have been no long-term sequelae from the extravasation.

Objective. The need for vigilance in patients who exhibit cisplatin drug hypersensitivity, even after successful rechallenge is illustrated. Clinical features. The patient was a 43-year-old woman presenting with relapsed ovarian cancer. On initial presentation 2 years earlier, she had developed a marked allergic reaction on her sixth cycle of cisplatin and cyclophosphamide chemotherapy. She was successfully rechallenged with cisplatin on re lapse, following pretreatment with antihistamines and corticosteroids. On the following cycle she redevel oped a major hypersensitivity reaction with tachycar dia, tachypnoea, hypotension, shakes, sweating and headache acutely into the cisplatin infusion, despite compliance with the previously effective premedica tion regimen. Case progress and outcome. Adrenaline, hy drocortisone, and promethazine were administered intravenously and oxygen and salbutamol were in haled and the patient settled over 10 minutes. Regular oral promethazine therapy was maintained overnight. Further therapy with cisplatin was withheld and the patient went on to complete 4 cycles of single agent paclitaxel, which were well tolerated. Conclusion. Patients exhibiting hypersensitivity reactions to platinum complexes that are successfully rechallenged following steroid and antihistamine pre- medication are still potentially at risk of systemic reactions. Vigilant patient care should be maintained on subsequent cycles and adrenaline, corticosteroids and antihistamines should be made available on stand-by.