Typical Medication Errors in Oncology: Analysis and Prevention Strategies

Müller, T.

doi:10.1159/000074148

Cited by 37 publications

(34 citation statements)

References 28 publications

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“…2006). While any class of drugs is susceptible to errors, chemotherapy presents special dangers because: (1) many drugs have a narrow therapeutic index; (2) are toxic even at therapeutic dosages; (3) chemotherapy regimens are highly complex; and (4) cancer patients are a vulnerable population with little tolerance (Muller 2003). This suggests that cancer patients may be severely affected by medication errors.…”

Section: Introductionmentioning

confidence: 99%

Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature

Schwappach¹,

Wernli

2010

European Journal of Cancer Care

113

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Medication errors in chemotherapy occur frequently and have a high potential to cause considerable harm. The objective of this article is to review the literature of medication errors in chemotherapy, their incidences and characteristics, and to report on the growing evidence on involvement of patients in error prevention. Among all medication errors and adverse drug events, administration errors are common. Current developments in oncology, namely, increased outpatient treatment at ambulatory infusion units and the diffusion of oral chemotherapy to the outpatient setting, are likely to increase hazards since the process of preparing and administering the drug is often delegated to patients or their caregivers. While professional activities to error incidence reduction are effective and important, it has been increasingly acknowledged that patients often observe errors in the administration of drugs and can thus be a valuable resource in error prevention. However, patients need appropriate information, motivation and encouragement to act as 'vigilant partners'. Examples of simple strategies to involve patients in their safety are presented. Evidence indicates that high self-efficacy and perceived effectiveness of the specific preventive actions increase likelihood of participation in error prevention. Clinicians play a crucial role in supporting and enabling the chemotherapy patient in approaching errors.

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Section: Introductionmentioning

confidence: 99%

Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature

Schwappach¹,

Wernli

2010

European Journal of Cancer Care

113

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“…There is also evidence that patients frequently observe, report and intercept errors 7–9. For example, patients often recognise when the wrong drugs or incorrect doses of the right drug are being given, or that devices such as infusion pumps malfunction 10 11. Unruh and Pratt report how chemotherapy patients, who usually have intense, recurring episodes of care, identify errors by checking concordance of prior experiences and information, more or less randomly obtained, to formulate rules and to check reality against these rules 12…”

Section: Introductionmentioning

confidence: 99%

Am I (un)safe here? Chemotherapy patients' perspectives towards engaging in their safety

Schwappach

Wernli

2010

BMJ Quality & Safety

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“…The error in managing the chemotherapeutic drugs produces specific hazards linked both to the restricted therapeutic index of such drugs, and to the toxicity that they manifest also at therapeutic doses 8 .…”

Section: Discussionmentioning

confidence: 99%

An unusual fatal case of overdose of Vinblastine and review of literature

Spagnolo

Mondello

Cardia

et al. 2016

Australian Journal of Forensic Sciences

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The pharmacological treatment of neoplasia is based on the use of chemotherapeutic substances. Chemotherapeutic agents can cause acute and chronic toxicity even at therapeutic doses. For this reason their overdose puts a patient's life at severe risk. This work presents an unusual fatal case of overdose subsequent to an accidental massive administration of Vinblastine (90 mg instead of 9 mg), slow bolus (five minutes), to a 33-yearold woman who suffered from Hodgkin's Lymphoma. The administration of the massive dose was due to a transcription error of the therapeutic treatment plan and miscommunication between the health professionals which caused the use of the wrong dose. The forensic investigation showed the systemic macroscopic and histological changes due to the toxic effect of Vinblastine on the body, by offering a realistic example of the microscopic tissue changes caused by the antineoplastic agent to different organs. Such evidence shows the importance of being very accurate when writing the therapeutic treatment plans and of counting on adequately-trained health care staff.

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Typical Medication Errors in Oncology: Analysis and Prevention Strategies

Cited by 37 publications

References 28 publications

Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature

Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature

Am I (un)safe here? Chemotherapy patients' perspectives towards engaging in their safety

An unusual fatal case of overdose of Vinblastine and review of literature

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