Medication Errors Increase in the Outpatient Oncology Setting

According to the FDA, these errors “cause at least one death every day and injure approximately 1.3 million people annually in the United States.” This problem has plagued the healthcare industry for decades. Physicians and nurses have been working to decrease the number of medical errors and with the development of technologies like the EHR and CPOE, there is hope that this number will decrease at much faster rate.

Medication errors are a big problem, especially when treating cancer patients. The article “Medication Errors Among Adults and Children With Cancer in the Outpatient Setting,” published in the Journal of Clinical Oncology, found “an 8.1% error rate for medications being administered to adults and children in outpatient oncology clinics.” The results are very general, but it showed that as the number of cancer patients taking chemotherapy medication as outpatients increases, so does the number of medical errors.

“The study is a start, but this has to be taken much farther,” said Tracy Gosselin, RN, MSN, AOCN, the associate chief nursing officer for oncology services at Duke University Health System. “At Duke, we’ve created a safety reporting system that allows us to look at all the errors that are made [and gives us] the ability to drill down into specific areas as well as to look at trends. It brings it down to individual actionable items.”

The study reviewed 1,379 records from clinic visits that occurred between September 1, 2005 and May 31, 2006 at one pediatric and three adult clinics. An error occurred in 22 out of 117 pediatric visits; 90 out of 1,262 adult visits were associated with an error. Of the 400 different medications that were administered, 17 accounted for all of the medical errors.

These findings underscore what many people already know—there is an urgent need to improve patient—physician communication. The study also highlights the fact oncology nurses play an integral part in the patient provider relationship because many nurses administer treatment to patents.

Kathleen Walsh, MD, MSc, assistant professor of pediatrics at the University of Massachusetts Medical School, said, “I believe that much more innovative solutions need to be developed over the next 5 to 10 years to improve communication between families and the healthcare system about how medication use and to better support home chemotherapy use in cancer patients.”

Many clinics are already implementing prevention strategies to decrease the number of errors. Debra Winkeljohn, RN, MSN, AOCN, CNS, clinical director of Hematology Oncology Associates in Albuquerque, NM, said that the nurses are “slowly getting involved with the oral chemo teaching, and giving patients all of the info that we normally give to those on IV chemo.”

Are you surprised at the number of medication errors that occur in cancer patients who get outpatient chemo? What prevention strategies do you implement when giving a cancer patient his or her first treatment?