Outpatient cancer care is riddled with medication errors, some of which have the potential to cause injury according to a study published in the Journal of Clinical Oncology.

 Kathleen Walsh and colleagues at the University of Massachusetts used chart review to study ordering and dosing processes for chemotherapeutic agents administered either in clinics or at home. 

They reviewed 12,000 medication orders from 1,262 adult and 117 pediatric visits to outpatient clinics in 4 regions of the US.

Medication errors complicated 7.1% of adult visits and 18.8% of pediatric visits, not counting those that were corrected before impacting care.

This translated to error rates per 1,000 medication orders of 8.2 and 24.1 for adults and children, respectively.

Of the 112 errors detected, 64 had the “potential to cause injury,” although actual injuries occurred in only 15 cases.

In adults, greater than 60% of all errors were associated with medication administration. In children, ordering errors accounted for 64% of all errors, but most of the serious errors also involved drug administration, especially when given at home.

Administration errors were typically caused by confusion over 2 sets of orders, one written at the beginning of a multi-week course of chemotherapy and the other on the day of administration.

“Requiring that medication orders not be written until lab results are reviewed on the day of administration may prevent (many) of the errors identified in our study,” they added.

The scientists also recommended demonstrating dosing techniques and the use of color-coding and line markings on syringes to reduce drug administration errors in the home.

Although their observations were consistent with other studies, Walsh’s team believed they would have detected even more errors had they directly observed drug administration procedures or interviewed patients and providers.

It’s a big, beautiful, bittersweet coincidence that Barack Obama’s inauguration takes place the day after Martin Luther King Day.

To honor Dr. King and acknowledge the extraordinary day to follow, Pizaazz will reprint excerpts today and tomorrow from a brilliant article in the Wall Street Journal by American historian, novelist and jazz critic Nat Hentoff. Enjoy!

“On…Martin Luther King’s Birthday, Jazz at Lincoln Center and the Rockefeller Foundation, also focusing on the next day’s presidential inauguration, will present at Kennedy Center “A Celebration of America.”

This focus on jazz as well as President-elect Barack Obama (who, I’m told, has John Coltrane on his iPod) should help make Americans aware of the largely untold story of the key role of jazz in helping to shape and quicken the arrival of the civil-rights movement.

For a long time, black and white jazz musicians were not allowed to perform together publicly. It was only at after-hours sessions that they jammed together, as Louis Armstrong and Bix Beiderbecke did in Chicago in the 1920s.

In the early 1940s, before I could vote, I often lied my way into Boston’s Savoy Café, where I first came to know jazz musicians. It was the only place in town where blacks and whites were regularly on the stand and in the audience. This led police occasionally to go into the men’s room, confiscate the soap, and hand the manager a ticket for unsanitary conditions.

There was no law in Boston against mixing the races, but it was frowned on in official circles.

Jim Crow was so accepted in the land that when Benny Goodman, during the 1930s, brought Teddy Wilson, and then Lionel Hampton, into his trio and quartets, it was briefly national news. And Artie Shaw later hired Billie Holiday and Roy Eldridge, both of whom often met Mr. Crow when having to find accommodations separate from the white musicians when on the road.

In a 1944 New Yorker profile of Duke Ellington, Richard Boyer told of a white St. Louis policeman enthusiastically greeting Ellington after a performance, saying: “If you’d been a white man, Duke, you’d have been a great musician.”

The Centers for Medicare and Medicaid Services recently released quality ratings for the 15,800 nursing homes that receive reimbursement from the 2 entitlement programs.

The ratings feature a 5-star scale with a one being poor and a 5 being well above average. They’re based on a combination of staffing information, results from health inspection surveys and a compendium of quality measures. Plans are to update them monthly.

The ratings can be found by clicking on the Nursing Home Compare feature at www.medicare.gov.

“Our goal in developing (the) quality rating system is to provide…a straightforward assessment of nursing home quality, with meaningful distinctions between high and low performing homes,” said CMS Acting Administrator Kerry Weems in a press release. 

Inspectors survey nursing homes annually to assure compliance with federal and state rules.  Information from the last 3 years worth of surveys was used to develop the ratings. 

The quality measurement system features 10 metrics including the percent of at-risk residents that developed pressure ulcers and the number whose mobility worsened after admission.

Staffing information relies on one metric—the severity-adjusted number of hours of nursing and other staff care, per patient-day.

In the first data release, 12% of the nation’s nursing homes received a 5-star rating, while 22% scored one star.  The remaining facilities were distributed evenly among the other rankings.

Thomas Hamilton, director of the CMS Survey and Certification Group reminded users that the ratings should be used in conjunction with other information sources.

“Families should also consult with their physician, talk to the state’s nursing home ombudsman or the state’s survey and certification office and, most importantly, visit the nursing home themselves,” he said.