Medication administration errors high among adult, pediatric outpatients with cancer

Medication errors, made in the clinic or at home, are high among adult and pediatric outpatients with cancer, according to a retrospective study.

Researchers conducted a review of adult and pediatric outpatient oncology clinic visits to examine medication errors — including rates and types — and the systems factors associated with them. Data were collected from three adult clinics and one pediatric clinic from the South, Southwest, North and Northwest. Visits were independently judged by two physicians for error occurrence and severity; the physicians listed possible interventions.

Records from 1,379 clinic visits, including 117 pediatric visits, were included in the analysis. Adult patients had a median age of 61 years and pediatric patients had a median age of 6 years. Breast (37%), lung (12%) and colon cancer (12%) were the most common adult diagnoses. Acute lymphogenous leukemia (74%), Hodgkin’s lymphoma (7%) and Langerhans cell histiocytosis (5%) were the most common among children.

The researchers reported 112 medication errors resulting in an overall rate of 8.1 errors per 100 clinic visits (95% CI, 6.8-9.7). Potentially harmful errors accounted for 57.1% of all errors; 15 of the 64 errors resulted in injury. Four percent of errors were caught before they reached the patient. Forty percent of errors occurred in chemotherapy and 20% of errors were associated with medicines used in the home. Errors were most commonly made during medication administration (56%) and medication prescribing (36%).

Ninety medication errors were identified in adults (7.1 per 100 visits; 95% CI, 5.7-8.6). Of those errors, 61% had the potential to cause harm, 11 of which did. In pediatric patients, 22 medication errors were identified (18.8 per 100 visits; 95% CI, 12.5-26.9) and 41% had the potential to cause harm. Four errors resulted in injury.

“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 wrote. – by Stacey L. Adams

J Clin Oncol. 2008; doi: 10.1200/JCO.2008.18.6072.

Systems for minimizing medication errors in the inpatient oncology setting often are not available in the outpatient or home care settings, and as a result, there are many more opportunities for errors in those locations. The study indicated that among medication errors, almost 60% had the potential to cause injury to the patient, which is a rather large and disturbing number. In addition, only 4% of the errors found in the study were actually intercepted prior to reaching the intended patient. The importance of this study is to demonstrate that these two settings, more than inpatient care, require an increase in risk reduction strategies in order to make them as safe as inpatient oncology treatment. The adoption of computerized order entry systems, messaging systems between prescribing physicians and treatment nurses or other professionals, and bar coding would help to improve medication safety in the outpatient setting. With the migration of care from inpatient to outpatient venues, technological improvements will assist providers in delivering timely, safe and effective care to patients in clinics or their homes. One conclusion that can be drawn from this study, which is acknowledged by the authors, is that medication errors are dramatically underreported, so the problems identified by this study are likely much more serious than this study discovered. This should be an even louder call for the use of technology to reduce such errors.

– Jeffrey Wahl, JD

HemOnc Today Editorial Board member