Outpatient Cancer Care Error-Prone

January 19th, 2009 | Sources: J. Clinical Oncology, MedPageToday

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.


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