Children with complex home care needs, such as children with cancer, are particularly vulnerable to medication errors. This longitudinal study used in-home observations and chart review to monitor 131 pediatric patients with leukemia or lymphoma for six months and found that 10% experienced adverse drug events due to medication errors in the home and 42% experienced a medication error with the potential for harm. Failures in communication was the most common contributing factor. Findings underscored a critical need for interventions to support safe medication use at home. Researchers concluded that improvements addressing communication with and among caregivers should be co-developed with families and based on human-factors engineering.

Patient engagement focuses on involving patients in detecting adverse events, empowering patients to speak up, and emphasizing the patient’s role in a culture of safety. Young people ages 16-25 with experiences in cancer care, and staff who support young people with cancer were asked about their experiences with three types of patient engagement strategies. Four themes for engaging young people emerged, including empowerment, transparency, participatory culture, and flexibility. Across all these was a fifth theme of transition from youth to adult care.  

Autopsies are an important tool for identifying diagnostic errors. This retrospective study of 821 pediatric cancer deaths found that 10% had a major diagnostic discrepancy between antemortem and postmortem diagnoses. These discrepancies primarily consisted of missed infections, missed cancer diagnoses, and organ complications.

Chemotherapy medications often have complex dosing which can lead to prescribing errors. This article describes the use of simulation-based training to improve pediatric hematology/oncology providers’ ability to identify and mitigate common chemotherapy ordering errors. The authors suggest that simulation-based training can serve as an alternative to systems-based electronic health record (EHR) improvements.

From the perspective of both developed and developing nations, the authors of this commentary discuss how the COVID-19 pandemic has impacted access to and delivery of cancer treatment and how the global pharmacy community is responding, including changing and expanding scopes of practice.

Using a cohort of adults diagnosed with breast, colorectal, lung or prostate cancer, this study examined the relationship between oncology-specific triggers and mortality. It found that patients with at least one trigger had a higher risk of death than patients without a trigger; this association was strongest for nonmetastatic prostate cancer and nonmetastatic colorectal cancer. Triggers most commonly associated with increased odds of mortality were bacteremia, blood transfusion, hypoxemia and nephrology consultation. These findings support the validity of cancer-specific trigger tool but additional research is needed to replicate these findings.

Missed or delayed cancer diagnoses can lead to delays in treatment and worse outcomes. This retrospective cohort study of new pediatric cancer patients found that there were diagnostic delays or errors in 28% of cases. The authors suggest that multiple visits for the same complaint should raise concerns about diagnostic accuracy.

Medication errors and nonadherence to medications contribute to increased use of health care resources. This study sought to better characterize the relationship between medication errors and nonadherence in children on oral chemotherapy. Researchers found both to occur in the same population and suggest that family and health system interventions could help mitigate errors and nonadherence in pediatric patients with cancer.

Drug shortages have become increasingly common in recent years, especially in the United States. Some pediatric chemotherapeutics have frequently been in short supply, posing serious risks to patient safety. This commentary describes an ethical framework developed by a multidisciplinary group of experts and a panel of peer consultants. The framework seeks to guide clinicians' decision-making around allocating life-saving chemotherapies and associated drugs for children with cancer. The authors describe methods for managing shortages by reducing waste. The guideline also provides clear reasoning for actual prioritization across and within common pediatric cancers during a drug shortage. For example, in cases where shortages lead to the inability to provide the standard of care for some children, the authors propose emphasizing curability and prognosis in determining who is likely to have the most benefit. In 2013, the FDA released a strategic plan for preventing drug shortages, but the problem has continued largely unabated.

Chemotherapy is a high-risk treatment that requires specific safety protocols. This commentary describes an effort that successfully determined and implemented best practices for chemotherapy administration in children. The intervention included an interdisciplinary program that reviewed current processes and evidence, utilized quality improvement tools, and established standardized techniques, exact times, and consistent documentation to augment safety associated with use of this medication.

This study sought to evaluate the safety and diagnostic accuracy of biopsies in pediatric patients with cancer. Analysis of biopsy procedures in children with suspected cancer over a 10-year period found few safety incidents and a low risk of diagnostic error.

To investigate the utility of a trigger tool in detecting adverse drug events (ADEs) in pediatric hematology and oncology patients, this study compared the tool with a voluntary reporting system. Implementation of the trigger tool led to inclusion of many cases that were not ADEs (false positives). In contrast, voluntary reporting did not identify all ADEs that were found using the trigger tool, implying under-reporting. These results reinforce prior research suggesting that multiple detection methods are needed to comprehensively detect ADEs. The authors advocate for triggers to be refined according to patient population and hospital setting to augment their usefulness. A previous AHRQ WebM&M perspective discusses the role of trigger tools in identifying ADEs and measuring patient safety.

This survey found that caregivers for pediatric oncology patients experience significant apprehension regarding medication errors but are hesitant to question professionals about potential errors. This finding underscores challenges to engaging patients in safety.

Children with cancer are particularly vulnerable to medication errors. This review describes how to enhance safe medication use in pediatric oncology through establishing a safety culture, integrating high reliability principles, and teamwork training.

Shortages of medications pose ethical, efficiency, and safety challenges for prescribers. This consensus statement makes recommendations to help guide policy development and promote proactive response to reduce the potential for pediatric chemotherapy drug shortages.