Originally published as JCO Early Release 10.1200/JCO.2008.18.6072 on December 29 2008

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Medication Errors Among Adults and Children With Cancer in the Outpatient Setting

From the Departments of Pediatrics and Geriatric Medicine, University of Massachusetts Medical School; Meyers Primary Care Institute, Fallon Community Health Plan, Fallon Clinic, Worcester, MA; The Center for Health Research/Southeast, Kaiser Permanente Georgia, Atlanta, GA; Division of Research, Kaiser Permanente Northern California; Kaiser Permanente Medical Care Program, Oakland, CA; and Lovelace Clinic Foundation, Albuquerque, NM.

Corresponding author: Kathleen E. Walsh, MD, MSc, University of Massachusetts Medical Center, Benedict Second Floor, 55 North Lake St, Worcester, MA 01655; e-mail: walshk02{at}ummhc.org.

Purpose Outpatients with cancer receive complicated medication regimens in the clinic and home. Medication errors in this setting are not well described. We aimed to determine rates and types of medication errors and systems factors associated with error in outpatients with cancer.

Methods We retrospectively reviewed records from visits to three adult and one pediatric oncology clinic in the Southeast, Southwest, Northeast, and Northwest for medication errors using established methods. Two physicians independently judged whether an error occurred ( = 0.65), identified its severity ( = 0.76), and listed possible interventions.

Results Of 1,262 adult patient visits involving 10,995 medications, 7.1% (n = 90; 95% CI, 5.7% to 8.6%) were associated with a medication error. Of 117 pediatric visits involving 913 medications, 18.8% (n = 22; 95% CI, 12.5% to 26.9%) were associated with a medication error. Among all visits, 64 of the 112 errors had the potential to cause harm, and 15 errors resulted in injury. There was a range in the rates of chemotherapy errors (0.3 to 5.8 per 100 visits) and home medication errors (0 to 14.5 per 100 visits in children) at different sites. Errors most commonly occurred in administration (56%). Administration errors were often due to confusion over two sets of orders, one written at diagnosis and another adjusted dose on the day of administration. Physician reviewers selected improved communication most often to prevent error.

Conclusion Medication error rates are high among adult and pediatric outpatients with cancer. Our findings suggest some practical targets for intervention, including improved communication about medication administration in the clinic and home.

Supported by a cooperative agreement (Grant No. 2 U18 HS 010391) from the Agency for Healthcare Research and Quality supporting the HMO Research Network Center for Education and Research on Therapeutics. K.E.W. was supported by a Robert Wood Johnson Physician Faculty Scholar award. The funders had no role in the design, analysis, and interpretation of the results or in the decision to publish.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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