Chemotherapy Errors Are Not Stamped Out
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Even for critical cancer chemotherapy, even at major cancer institutions, physicians are making mistakes that have the potential for harming patients.
A study of outpatient chemotherapy errors at the Dana-Farber Cancer Institute here found an overall medication error rate of 3%, with a serious error rate of 2%, reported Tejal K. Gandhi, M.D., M.P.H., of Brigham and Women’s Hospital and colleagues.
In a prospective cohort study involving two adult and one pediatric outpatient chemotherapy units at the institute, published online by the journal Cancer, the researchers reviewed 10,112 medication orders for 1,606 patients given between March and December 2000.
The adult units used a computerized order entry system, and the pediatric unit used handwritten orders. The error rate was 3% for the adult units (249 of 8,008 orders) and 3% also for the pediatric unit (57 of 2,104 orders).
In adults, 82% of the errors had the potential to cause harm—defined as the potential to cause an adverse drug event. In children, 60% of the errors were potentially harmful. Of these potentially harmful mistakes, about one-third could have been life-threatening.
In the adult clinics, the most frequent errors were omission of dosages and failure to discontinue orders. In the pediatric clinic, the most common errors were incorrect dosages and failure to discontinue.
Pharmacists and nurses intercepted 45% of errors before they reached the patient. None of the errors actually caused patient harm.
Based on these results, the institute implemented changes to its system. “All chemotherapy regimens are now standardized and templated within the computerized order entry system, thereby reducing the likelihood of drug entry errors and providing nurses and pharmacists with a more uniform set of therapies,” the study authors said.
The authors pointed out that these results may not be applicable to other cancer centers. The study “was performed at only one independent oncology center that has a strong culture of patient safety and a sophisticated chemotherapy ordering system. However, this center also has a high rate of use of investigational protocols and fewer standard regimens.”
The investigators concluded, “Cancer patients are increasingly receiving highly toxic and complex chemotherapy in the outpatient setting. In addition, more new chemotherapeutic agents are being introduced each year that clinicians may be less familiar with. Delivering chemotherapy as safely as possible requires continually examining the systems by which chemotherapy is administered.”
In an accompanying editorial, Jonathan R. Nebeker, M.D., of the University of Utah in Salt Lake City, and Charles L. Bennett, M.D., Ph.D., M.P.P., of Northwestern University in Chicago, said that the study “represents an important step in implementing computerized solutions and other system changes that are designed to improve pharmaceutical safety in the ambulatory oncology setting.”
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