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Medication errors common in outpatient pediatric cancer care
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Medication errors are common among pediatric patients with cancer who receive care at home, according to results of a prospective, observational multisite study.
The rate of preventable medication-related injuries among the outpatient population was comparable or higher than that reported in prior studies of hospitalized patients, researchers said.
“As the use of oral chemotherapy rises, responsibility for the management of these toxic medications shifts from nurses to parents and patients,” Kathleen E. Walsh, MD, MSc, of the departments of pediatrics and medicine at the University of Massachusetts School of Medicine, and colleagues wrote. “Given the variety of error types detected in our study, multiple support tools will likely [be] necessary to prevent errors in home medication use in children with cancer.”
Walsh and colleagues recruited 92 patients from three pediatric oncology clinics between 2007 and 2011.
The researchers reviewed the patients’ medical records and prescription doses. A trained nurse visited the patients’ homes to review medication bottles and observe administration. Two physicians evaluated the findings and independently judged the frequency and severity of errors.
The researchers reviewed 963 medications and observed 242 medication administrations. Seventy-two medication errors occurred, including four that led to significant patient injury.
An additional 40 errors had the potential to cause injury, the researchers wrote. Of those potential injuries, two were classified as life-threatening, 13 were characterized as serious and 25 were deemed significant.
Researchers calculated a weighted overall rate of 70.2 errors per 100 patients (95% CI, 58.9-81.6). They reported a weighted rate of errors with injury of 3.6 per 100 patients (95% CI, 1.7-5.5) and a rate of errors with potential for injury of 36.3 per 100 patients (95% CI, 29.3-43.3).
Administration errors often were caused by miscommunication between parents and clinicians, or between in-home caregivers, regarding changes in oral chemotherapy doses, the researchers reported.
However, many errors also occurred during the administration of nonchemotherapy medications.
“Given that children with cancer see their oncologist more frequently than their primary care physician, oncologists may need to inquire more about nonchemotherapy medication use,” they wrote.
Researchers noted potential limitations of the study. Due to methodology, the sample size was small, and administration errors that occurred when observers were not in the home were not detected. Also, the possibility that parents changed their behavior when observers were in the home — as well as the fact that the population studied was well educated — may have caused the error rate to be underestimated, they wrote.
Disclosure: The researchers report no relevant financial disclosures.
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