Search results for "United States of America"

This systematic review of quality and safety practices for oral chemotherapy found that telephone calls from nurses identified adverse medication events and supported adherence. Technology-enabled approaches such as text messaging, interactive voice response, and video-observed therapy have not been effective to date.

Prescribing and administering chemotherapy involves complex processes that are vulnerable to error. This study discussed how improvement efforts, including standardization and minimizing interruptions, led to a decrease in the rate of chemotherapy errors reaching patients at a large urban academic pediatric medical center.

Administration errors involving chemotherapeutic agents can result in patient harm. This set of standards provides guidance to help ensure reliable use of these high-alert medications for both adult and pediatric patients. Components of the revised standards are expanded to include two-person verification, vinca alkaloid mini-bag administration, and labeling enhancements for home-based chemotherapy.

Vincristine is a chemotherapy agent that can have serious consequences if administered incorrectly. Drawing from guidelines and expert opinion regarding vincristine administration, this campaign advocates for diluting vincristine via a mini-IV drip bag to reduce the likelihood of dangerous dosage mistakes.

Oral chemotherapy regimens are complex and may lead to severe adverse drug events. In this pilot study, nearly half of patients enrolled in a pharmacist-run oral chemotherapy monitoring clinic experienced a medication-related problem. This finding is consistent with prior studies that demonstrated pharmacist oversight improves safety of oral chemotherapy.

Chemotherapy administration has a well known potential for errors. This pre–post study found that implementation of an electronic health record–facilitated, pharmacist-led, standardized ordering and monitoring program for oral chemotherapy led to better identification of prescribing errors. This research adds to the evidence for the role of pharmacists in making cancer care safer.

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.

Chemotherapy is a complicated process, and it is vulnerable to error due to factors that can affect the various steps involved. This commentary describes how one multidisciplinary cancer center designed and applied a taxonomy to report and monitor chemotherapy errors. The authors summarize the results of the work and provide suggestions for organizations that seek to develop similar tracking and analysis methods.

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.

In 2012, more than 350 organizations from 13 countries participated in the initial Institute for Safe Medication Practices self-assessment for oncology. This study describes results from this baseline survey, which revealed key opportunities for improvements in the safe delivery of chemotherapy. For example, many institutions have still not followed best practices for the administration of vincristine. In addition, less than half of respondents had fully implemented safety processes for oral chemotherapy orders. A prior AHRQ WebM&M commentary describes a patient who inadvertently received the wrong chemotherapy regimen and explores the high risks associated with inpatient chemotherapy.

To illustrate hazards associated with dispensing more than one dose of certain medications, this newsletter article describes an incident involving an accidental overdose of self-administered oral chemotherapy which resulted in a patient's death. Recommendations to reduce the potential for errors include ensuring labels conform to FDA labeling practices, dispensing only single doses, and providing medication counseling and written instructions for patients.

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.

Various technologies have been developed to reduce medication errors. Examining the research around implementation of these technologies, such as computerized provider order entry and bar-code medication administration, this review identifies their benefits and drawbacks on chemotherapy administration safety.

This newsletter article reports on concerns associated with chemotherapy preparations due to variations in concentration and recommends standardized preparation processes to address such risks.

Chemotherapy is a notoriously high-risk medication. A chemotherapy medication prescribing error was responsible for one of the most infamous patient safety cases, the tragic death of Boston Globe reporter Betsy Lehman. Computerized provider order entry is thought to reduce prescribing errors, but it has not specifically been studied for chemotherapy. In this study, implementation of standardized templates for chemotherapy ordering was associated with a significant reduction in prescribing errors as well as administration errors. While this study is promising, a recent AHRQ WebM&M commentary illustrates that even standardized ordering protocols cannot entirely prevent chemotherapy errors.

This newsletter article discusses risks associated with vincristine administration, contributing factors, and strategies to prevent errors.

In this study, computer alerts for possible drug interactions between chemotherapy orders and ambulatory medications sometimes led physicians to change their orders, which could prevent adverse drug events in these vulnerable patients.

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.