Intricate cancer treatments raise drug error risk, study says

Complex pharmacological regimens employed in outpatient cancer treatment and lagging use of health information technology in the specialty have created alarmingly high rates of medication errors, according to a study published in the Jan. 1 Journal of Clinical Oncology.

A review of 1,379 patients' medical charts and nearly 12,000 medication doses at four oncology clinics around the country found a 7.1% rate of outpatient medication errors in adults -- more than double the rate found in a December 2005 study. Slightly less than 1% of the adult medication errors caused injury.

The rate of medication errors among children was 18.8%, with 3.4% of the errors causing injury. More than half the errors in all patients had the potential to cause injury.

Among children, more than half of the potentially harmful errors that physician reviewers identified were related to home medication use.

The medication errors were discovered because they had been recorded in the medical chart in some way, said lead author Kathleen E. Walsh, MD, assistant professor of pediatrics at the University of Massachusetts Medical School. The study could not determine the extent of other medication errors that happened at home but were not discovered in the clinic.

"What we are finding here is the tip of the iceberg," Dr. Walsh said. "I'm a regular pediatrician, and I don't provide the kind of support these families get. The problem is, it's so, so complicated for families taking care of kids getting chemotherapy at home. We need highly innovative solutions to help families at home."

No silver bullet

Sacramento, Calif., oncologist Robert S. Miller, MD, said the results were "sobering" and the error rate "unacceptably high."

Health IT could help address the problem, he said. One of the four clinics used a locally developed computer physician order entry system and experienced only two medication errors. The clinic had a rate of one error for every 156 patient visits.

"The way most chemotherapy is ordered in the United States, it is still done on paper and done in an environment that does not have a lot of error-checking built in," Dr. Miller said.

But, he added, the rate of home medication errors found in the study shows that electronic health records are not a cure-all.

"Health IT is a bullet, but not the silver bullet," Dr. Miller said. "More so than ever before in the history of our specialty we're using oral medications, so compliance is critical when it's basically the patient or the family responsible for correct delivery of the dose."

Among the interventions most likely to prevent errors were dose double-checking, patient bar coding, electronic ordering, standardized ordering sheets and patient education about home medications, according to the study, available online (link).

Dr. Walsh said future studies will focus on how cancer medications are administered, and sometimes wrongly administered, in the home.