Search results for "United States of America"

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.

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.

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.

An Institute of Medicine report raised serious concerns about the safety and quality of cancer care. This study found that implementation of a checklist for outpatient visits was associated with increased accuracy of medication lists and clinical documentation in a pediatric oncology clinic.

The ability to treat many types of cancer with oral chemotherapy has benefited patients by minimizing hospitalizations, but it also places the burden to avoid medication errors on them as they must administer risky medications correctly. Prior studies have shown that adults and children with cancer are particularly vulnerable to medication errors and that most oncology practices do not have specific safeguards in place to improve oral chemotherapy medication safety. This study used direct observation (during home visits) to determine the epidemiology of medication errors among children with cancer and found a staggeringly high incidence of 36 potentially harmful errors per 100 patients—higher than some studies of hospitalized patients. The authors judged that more than one-third of the errors could have been prevented by better communication between patients and physicians.

A multidisciplinary, pharmacy-associated intervention halved the number of pediatric chemotherapy errors at a single institution (from 3.9 to 1.8 per 1000 medications dispensed) but failed to achieve its goal of a Six Sigma error rate.

The nationwide unavailability of certain prescription medications has posed a potential patient safety problem, as these shortages have been increasingly common over the past few years. This study shows clear evidence that drug shortages can result in patient harm. In 2009, a shortage of mechlorethamine (a standard component of chemotherapy regimens for childhood leukemia) forced oncologists to treat patients with an alternative agent, cyclophosphamide (which was thought to be equally effective). This article demonstrates that children who received cyclophosphamide clearly had a higher rate of treatment failure, resulting in the need for further chemotherapy and bone marrow transplantation. This finding adds to other recent studies documenting clinical consequences directly related to drug shortages.

This newspaper article discusses second opinions as a tactic for catching diagnostic errors.

This case report illustrates the benefits of utilizing a rapid response team (RRT) in the outpatient setting, and discusses broader findings of RRT use at a pediatric hospital.

This article discusses how a criminal prosecution has deeply affected an Ohio pharmacist who lost his license and is serving a prison sentence for failing to detect a medical error, which led to the death of a child.

Medication errors in patients with cancer are a known safety concern, both with chemotherapy orders and with potential drug interactions and duplicate prescriptions. This study examined nearly 1500 adult and pediatric outpatient visits involving 12,000 medications to describe the prevalence and potential prevention strategies for medication errors. Error rates were found to be 7.1% in the adult visits and 18.8% in the pediatric visits with more than half of all errors occurring during administration. The latter finding was notable because investigators discovered that administration errors often resulted from confusion over two sets of orders written at different times. The authors advocate for greater attention to and communication about error prevention strategies given the trend toward cancer treatment in the outpatient setting.

Bar-coding technology has been associated with reductions in drug-dispensing errors but has also been associated with unintended consequences. This study implemented a bar-coding system for laboratory specimen identification, with careful attention to integrating the new system within existing laboratory workflow.

Although adverse drug events (ADEs) are relatively frequent in outpatient chemotherapy, little is known about ADE rates in pediatric cancer patients. This study examined data from the Medmarx voluntary reporting system to characterize the frequency and severity of such errors in pediatric patients. More than 300 errors were reported over the 5-year study period, approximately 15% of which resulted in clinical consequences (ie, the need for additional patient monitoring or therapeutic intervention). Errors in administering medications were the most common cause of adverse events, as noted in a previous study. The authors note that these errors probably would not be prevented by safety interventions such as computerized physician order entry.

The authors describe the implementation of daily care rounds. Surveys revealed that staff thought these rounds improved communication and patient safety.

The authors describe their experience using computerized provider order entry (CPOE) to improve the safety of chemotherapy ordering at a children's hospital.