Oral outpatient chemotherapy medication errors in children with acute lymphoblastic leukemia

Abstract

BACKGROUND. Although medication errors are 1 of the most common types of medical errors, their frequency in pediatric patients receiving oral outpatient chemotherapeutic agents is unknown. The prescribing, dispensing, and parental administration of these medications to children receiving treatment for acute lymphoblastic leukemia (ALL) were systematically reviewed to determine the rate and types of medication errors occurring in these patients. METHODS. During a 2‐month study period, parents of children with ALL were contacted and asked to participate in the study before a regularly scheduled clinic appointment. At the visit, the parent demonstrated how each medication was administered. A pediatric oncologist reviewed the medical record to determine the correct treatment regimen for study patients. After comparing the correct treatment regimen with what was administered, a classification of “no medication error,” “medication error,” or “cannot determine” due to insufficient information was made for each indicated drug. Identified medication errors were subclassified as prescribing, dispensing, or administration errors. RESULTS. Data on 172 chemotherapeutic medications for 69 patients were analyzed. One or more errors occurred with 17 of the 172 (9.9%) medications; a classification of “cannot determine” was made for 12 (7.0%) medications. Among the 17 medication errors there were 12 (7.0%) administration errors and 5 (2.9%) prescribing errors. There were no pharmacy dispensing errors. All errors were due to incorrect dosing or failure to administer an indicated medication. At least 1 medication error occurred in 13 of the 69 (18.8%) study patients. CONCLUSIONS. Prescribing and administration medication errors occurred with nearly 10% of chemotherapeutic drugs administered to outpatient children with ALL. Systematic changes, including computerized physician order entry and simplification of treatment protocols, should be considered. Cancer 2006. © 2006 American Cancer Society.

Medication Errors in the Home: A Multisite Study of Children With Cancer

“…17 Gandhi et al 15 found that 2% of pediatric oncology clinic visits and 3% of adult visits involved an error. Taylor et al 20 observed parents measuring chemotherapy in the clinic and found mistakes in 10%; we found fewer errors. By using medical record review, bottle review, and direct observation in the home, we were able to identify a broad range of error types that occur in outpatient pediatric oncology care.…”

“…Other studies ask parents to demonstrate proper dosing of home medications while in the clinic. [20][21][22] These approaches assess only part of the entire process of home medication use and are subject to sampling bias. A comprehensive investigation of the spectrum of errors in medication use at home, assessing frequency and severity, is needed to identify vulnerabilities, target education, and design interventions.…”

Home Medication Support for Childhood Cancer: Family-Centered Design and Testing

“…The rate of medication errors (4.5 per 100 medications) we found is consistent with those from prior studies of home medication use in children with cancer. 3,5 This project has several limitations. It occurred at a single site study and was designed to assess feasibility and parent satisfaction, not impact on error rates.…”

“…[1][2][3][4] Home medication use in children with cancer is highly complex: doses change from day to day, liquids are difficult to measure, pills must be cut and crushed, and children with cancer take a median of 10 medications daily. 2,4 In a recent editorial, Landrigan et al called for more effective support for parents caring for ill children at home.…”

Role of pharmacists in optimizing the use of anticancer drugs in the clinical setting

“…Chemotherapy error rates have been reported at 3%-16%. 14,15 Errors in ordering are most common, followed by administration and then dispensing. Missing or improperly written premedication orders prior to chemotherapy and missing treatment parameters could also lead to potentially serious adverse drug reactions.…”