One in five children with cancer receive wrong chemotherapy doses

ChemotherapyA study of nearly 1,400 adult and pediatric cancer patients published in the Journal of Clinical Oncology has found that 19% of children taking chemotherapy drugs in outpatient clinics or at home were subject to some sort of medication error.  In addition, 7% of adult cancer outpatients also were on the receiving end of chemotherapy mistakes.

Alarmingly, approximately 40% medication errors in children had the potential to cause harm, and four children were actually injured.

“As cancer care shifts from the hospital to the outpatient setting, adults and children with cancer receive more complicated, potentially toxic medication regimens in the clinic and home,” said Dr Kathleen Walsh, study leader and assistant professor of pediatrics at the University of Massachusetts Medical School.  Given that outpatients are essentially required to administer these complex regimens themselves without any medical guidance, errors in medication are, therefore, quite likely.

In this study, the authors retrospectively examined medical records from outpatient visits at three adult and one pediatric oncology clinic.  In total, 1,262 adult patient visits involving 10,995 medications and 117 pediatric visits involving 913 medications were assessed.

Of the adult visits, 90 were associated with a medication error, whereas 22 pediatric visits involved a chemotherapy mistake. More than 70% of the errors in children occurred at home, whereas in adults chemotherapy errors were much more likely in the clinic (>50% of cases).

One of the key types of medication error recorded in adults was administration of an incorrect dose due to confusion over conflicting instructions. In some cases, medication orders for several months of chemotherapy would be written at the beginning of treatment, and doses would then be adjusted as needed at each clinic visit. Patients thus had an initial set of orders and a modified set instructions written on the day of the outpatient visit, causing much bewilderment when it came to the time of administration.

A considerable proportion of the medication errors in children were due to parents’ confusion about instructions, which resulted in the child receiving the wrong dose or the wrong number of doses per day.

“Requiring that medication orders be written on the day of administration, following review of lab results, may be a simple strategy for preventing errors among adults, while most of the errors involving children may have been avoided by better communication and support for parents of children who use chemotherapy medications at home,” said Dr Walsh.

In addition, information technology such as computer order entry, electronic medication administration records and bar-coding – which have proved effective in hospitals – might also help prevent medication errors in an outpatient setting.

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Walsh KE et al. (2008) Medication Errors Among Adults and Children With Cancer in the Outpatient Setting. Journal of Clinical Oncology DOI: 10.1200/JCO.2008.18.6072

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