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Fitzner K, Oteng-Mensah F, Donley P, Heckinger EA. Safety of Cancer Therapies: At What Cost? Popul Health Manag 2017; 20:318-328. [DOI: 10.1089/pop.2016.0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Patrick Donley
- Economics Department, DePaul University, Chicago, Illinois
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Farias TF, Aguiar KDS, Rotta I, Belletti KMDS, Carlotto J. Implementing a clinical pharmacy service in hematology. EINSTEIN-SAO PAULO 2017; 14:384-390. [PMID: 27759828 PMCID: PMC5234751 DOI: 10.1590/s1679-45082016ao3667] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/20/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: To implement a clinical pharmacy service focused on the comprehensive review of antineoplastic drugs used in therapy of hematological diseases. Methods: An interventional study was conducted in a Brazilian tertiary teaching hospital in two different periods, with and without a clinical pharmacy service, respectively. This service consisted of an antineoplastic prescription validation (analysis of patients' characteristics, laboratory tests, compliance with the therapeutic protocol and with pharmacotechnical parameters). When problems were detected, the pharmacist intervened with the physician or another health professional responsible for the patient. Inpatients and outpatients with hematological diseases were included. Results: We found an increased detection of drug-related problem by 106.5% after implementing the service. Comparing the two periods, an increase in patients' age (26.7 years versus 17.6 years), a predominance of outpatients (54% versus 38%), and an increase in multiple myeloma (13% versus 4%) and non-Hodgkin lymphoma (16% versus 3%) was noted. The most commonly found problems were related to dose (33% versus 25%) and cycle day (14% versus 30%). With regard to clinical impact, the majority had a significant impact (71% versus 58%), and in one patient from the second period could have been fatal. The main pharmaceutical interventions were dose adjustment (35% versus 25%) and drug withdrawal (33% versus 40%). Conclusion: The pharmacy service contributed to increase the detection and resolution of drug-related problems, and it was an effective method to promote the safe and rational use of antineoplastic drugs.
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Affiliation(s)
| | | | - Inajara Rotta
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Juliane Carlotto
- Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Huertas-Fernández MJ, Martínez-Bautista MJ, Rodríguez-Mateos ME, Zarzuela-Ramírez M, Muñoz-Lucero T, Baena-Cañada JM. Implementation of safeguards to improve patient safety in chemotherapy. Clin Transl Oncol 2017; 19:1099-1106. [DOI: 10.1007/s12094-017-1645-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/13/2017] [Indexed: 11/24/2022]
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Walsh EK, Hansen CR, Sahm LJ, Kearney PM, Doherty E, Bradley CP. Economic impact of medication error: a systematic review. Pharmacoepidemiol Drug Saf 2017; 26:481-497. [PMID: 28295821 DOI: 10.1002/pds.4188] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/15/2016] [Accepted: 01/30/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error. METHODS PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed. RESULTS A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population. CONCLUSIONS Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elaine K Walsh
- Department of General Practice, University College Cork, Cork, Ireland
| | - Christina Raae Hansen
- School of Pharmacy, University College Cork, Cork, Ireland.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland.,Mercy University Hospital, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health University College Cork, Cork, Ireland
| | - Edel Doherty
- Department of Economics, National University of Ireland Galway, Galway, Ireland
| | - Colin P Bradley
- Department of General Practice, University College Cork, Cork, Ireland
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Saad A, Der-Nigoghossian CA, Njeim R, Sakr R, Salameh P, Massoud M. Prescription Errors with Chemotherapy: Quality Improvement through Standardized Order Templates. Asian Pac J Cancer Prev 2017; 17:2329-36. [PMID: 27221940 DOI: 10.7314/apjcp.2016.17.4.2329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. INITIAL ASSESSMENT An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. CHOICE OF SOLUTION Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. IMPLEMENTATION The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. EVALUATION Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. LESSONS LEARNED Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.
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Affiliation(s)
- Aline Saad
- Department of Pharmacy Practice School of Pharmacy Lebanese American University Byblos, Lebanon E-mail :
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Dalton K, Byrne S. Role of the pharmacist in reducing healthcare costs: current insights. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2017; 6:37-46. [PMID: 29354549 PMCID: PMC5774321 DOI: 10.2147/iprp.s108047] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Global healthcare expenditure is escalating at an unsustainable rate. Money spent on medicines and managing medication-related problems continues to grow. The high prevalence of medication errors and inappropriate prescribing is a major issue within healthcare systems, and can often contribute to adverse drug events, many of which are preventable. As a result, there is a huge opportunity for pharmacists to have a significant impact on reducing healthcare costs, as they have the expertise to detect, resolve, and prevent medication errors and medication-related problems. The development of clinical pharmacy practice in recent decades has resulted in an increased number of pharmacists working in clinically advanced roles worldwide. Pharmacist-provided services and clinical interventions have been shown to reduce the risk of potential adverse drug events and improve patient outcomes, and the majority of published studies show that these pharmacist activities are cost-effective or have a good cost:benefit ratio. This review demonstrates that pharmacists can contribute to substantial healthcare savings across a variety of settings. However, there is a paucity of evidence in the literature highlighting the specific aspects of pharmacists' work which are the most effective and cost-effective. Future high-quality economic evaluations with robust methodologies and study design are required to investigate what pharmacist services have significant clinical benefits to patients and substantiate the greatest cost savings for healthcare budgets.
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Affiliation(s)
- Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Neuss M, Gilmore T, Belderson K, Billett A, Conti-Kalchik T, Harvey B, Hendricks C, LeFebvre K, Mangu P, McNiff K, Olsen M, Schulmeister L, Von Gehr A, Polovich M. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. Oncol Nurs Forum 2017; 44:31-43. [PMID: 28067033 DOI: 10.1188/17.onf.31-43] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To update the American Society of Clinical Oncology (ASCO)/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were first published in 2009 and updated in 2011 to include inpatient settings. A subsequent 2013 revision expanded the standards to include the safe administration and management of oral chemotherapy. A joint ASCO/ONS workshop with stakeholder participation, including that of the Association of Pediatric Hematology Oncology Nurses and American Society of Pediatric Hematology/Oncology, was held on May 12, 2015, to review the 2013 standards. An extensive literature search was subsequently conducted, and public comments on the revised draft standards were solicited. Results The updated 2016 standards presented here include clarification and expansion of existing standards to include pediatric oncology and to introduce new standards: most notably, two-person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, and labeling of medications dispensed from the health care setting to be taken by the patient at home. The standards were reordered and renumbered to align with the sequential processes of chemotherapy prescription, preparation, and administration. Several standards were separated into their respective components for clarity and to facilitate measurement of adherence to a standard. Conclusion As oncology practice has changed, so have chemotherapy administration safety standards. Advances in technology, cancer treatment, and education and training have prompted the need for periodic review and revision of the standards. Additional information is available at http://www.asco.org/chemo-standards.
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Neuss MN, Gilmore TR, Belderson KM, Billett AL, Conti-Kalchik T, Harvey BE, Hendricks C, LeFebvre KB, Mangu PB, McNiff K, Olsen M, Schulmeister L, Von Gehr A, Polovich M. 2016 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards, Including Standards for Pediatric Oncology. J Oncol Pract 2016; 12:1262-1271. [DOI: 10.1200/jop.2016.017905] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To update the ASCO/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards and to highlight standards for pediatric oncology. Methods The ASCO/ONS Chemotherapy Administration Safety Standards were first published in 2009 and updated in 2011 to include inpatient settings. A subsequent 2013 revision expanded the standards to include the safe administration and management of oral chemotherapy. A joint ASCO/ONS workshop with stakeholder participation, including that of the Association of Pediatric Hematology Oncology Nurses and American Society of Pediatric Hematology/Oncology, was held on May 12, 2015, to review the 2013 standards. An extensive literature search was subsequently conducted, and public comments on the revised draft standards were solicited. Results The updated 2016 standards presented here include clarification and expansion of existing standards to include pediatric oncology and to introduce new standards: most notably, two-person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, and labeling of medications dispensed from the health care setting to be taken by the patient at home. The standards were reordered and renumbered to align with the sequential processes of chemotherapy prescription, preparation, and administration. Several standards were separated into their respective components for clarity and to facilitate measurement of adherence to a standard. Conclusion As oncology practice has changed, so have chemotherapy administration safety standards. Advances in technology, cancer treatment, and education and training have prompted the need for periodic review and revision of the standards. Additional information is available at http://www.asco.org/chemo-standards .
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Affiliation(s)
- Michael N. Neuss
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Terry R. Gilmore
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Kristin M. Belderson
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Amy L. Billett
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Tara Conti-Kalchik
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Brittany E. Harvey
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Carolyn Hendricks
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Kristine B. LeFebvre
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Pamela B. Mangu
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Kristen McNiff
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - MiKaela Olsen
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Lisa Schulmeister
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Ann Von Gehr
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
| | - Martha Polovich
- Vanderbilt Ingram Cancer Center, Nashville TN; American Society of Clinical Oncology, Alexandria, VA; Children’s Hospital Colorado, Aurora, CO; Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; The Breast Center, Bethesda, MD; Oncology Nursing Society, Pittsburgh, PA; Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; New Orleans, LA; The Permanente Medical Group, San Jose, CA; and Byrdine F. Lewis School of Nursing and Health Professions, Atlanta, GA
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Chobanuk J. [Not Available]. Can Oncol Nurs J 2016; 26:256-257. [PMID: 31148687 PMCID: PMC6516307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Janice Chobanuk
- Directrice, Ambulatory Care and Systemic Therapy, Community Oncology, Alberta Health Services, Cancer Control Alberta Edmonton, Alberta
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60
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Chobanuk J. Medication errors and shift to a culture of patient safety and high reliability. Can Oncol Nurs J 2016; 26:255. [PMID: 31148681 PMCID: PMC6516308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Janice Chobanuk
- Director Ambulatory Care and Systemic Therapy, Community Oncology, Alberta Health Services, Cancer Control Alberta Edmonton, Alberta
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61
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Han JM, Ah YM, Suh SY, Jung SH, Hahn HJ, Im SA, Lee JY. Clinical and economic impact of pharmacists’ intervention in a large volume chemotherapy preparation unit. Int J Clin Pharm 2016; 38:1124-32. [DOI: 10.1007/s11096-016-0339-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/17/2016] [Indexed: 11/30/2022]
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Patel K, Jay R, Shahzad MW, Green W, Patel R. A systematic review of approaches for calculating the cost of medication errors. Eur J Hosp Pharm 2016; 23:294-301. [PMID: 31156868 DOI: 10.1136/ejhpharm-2016-000915] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/05/2016] [Accepted: 05/10/2016] [Indexed: 01/22/2023] Open
Abstract
Introduction Although medication errors may cause significant morbidity and mortality, the true cost of avoidable harm from such errors is unclear. While studies describe different methods for calculating a financial cost from an error, there remains variability in the way calculations are conducted depending on the clinical context. This review aimed to investigate the range of approaches for calculating medication error costs across healthcare settings. Methods A systematic review was carried out with a duplicate data extraction approach and mixed methods data synthesis. Medline, Embase and Web of Science were searched for studies published between 1993 and 2015. Studies that explicitly described a method for calculating medication error cost were included. The variables used for the calculations and a description of the approach for calculating errors were reported. Results 21 studies were included in the final review. There was wide variation in the way calculations were undertaken, with some calculations using a single variable only and others using several variables in a multistep approach. Few calculations included indirect costs, such as loss of earnings for the patient, and only one calculation considered opportunity cost. The majority of studies presented direct medication error costs whereas others approximated error costs from the savings made following an intervention. Conclusions There are a wide range of methods used for calculating the cost of medication errors. The diversity arises from the number of variables used in calculations, the perspective from which the calculation is conducted from, and the degree of economic rigour applied by researchers.
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Affiliation(s)
- Krishan Patel
- Biological Sciences and Psychology Department of Medical & Social Care Education, College of Medicine, Leicester, UK
| | - Robert Jay
- Biological Sciences and Psychology Department of Medical & Social Care Education, College of Medicine, Leicester, UK
| | | | - William Green
- Operations and Knowledge Management-School of Management, University of Leicester, University Road, Leicester, UK
| | - Rakesh Patel
- Biological Sciences and Psychology Department of Medical & Social Care Education, College of Medicine, Leicester, UK
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63
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Enhancement of oncology nursing education in low- and middle-income countries: Challenges and strategies. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
PURPOSE Chemotherapy is a high-risk medication and is the second most common cause of fatal medication errors. The ordering process can be unsafe and inefficient, putting patients at risk for medication errors. The aim of this project was to decrease the number of chemotherapy order forms with at least one deviation by 50% within 5 months. METHODS A multidisciplinary team identified causes for variance in form completion, deficits in knowledge of ordering processes, and acceptance of incomplete orders by the staff. The Plan, Do, Study, Act improvement methodology evaluated the chemotherapy ordering process and found different types of deviations on order forms. Interventions consisted of educating physicians on entering complete information on orders, instituting same-day laboratory work on the day of the physician's visit, standardizing laboratory parameters, performing audits of the order forms manually, and educating nurses on not accepting orders with deviations. RESULTS All order forms were reviewed, and data were collected on different types of deviations. The following deviations were identified: laboratory test results were not being entered into the order form within 7 days, physicians were not providing their name and pager number, and the days of the chemotherapy cycle were missing from the order forms. Before the intervention, 70.1% of the chemotherapy order forms had at least one deviation. After 5 months of interventions, there was a reduction of 19% in the number of order forms with at least one deviation. Follow-up at 6 months and 1 year showed continuing reductions in the number of chemotherapy orders with at least one deviation. CONCLUSION Improvement was a result of collaboration between interdisciplinary departments. The original goal was surpassed as a result of educating physicians and staff and standardizing the ordering process. If the number of deviations in chemotherapy order forms is decreased, oncology patients will receive safe, efficient, and quality care.
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65
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Bins S, Ratain MJ, Mathijssen RHJ. Conventional dosing of anticancer agents: precisely wrong or just inaccurate? Clin Pharmacol Ther 2015; 95:361-4. [PMID: 24646486 DOI: 10.1038/clpt.2014.12] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S Bins
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M J Ratain
- Department of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - R H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Mathaiyan J, Jain T, Dubashi B, Reddy KS, Batmanabane G. Authors' reply. J Pharmacol Pharmacother 2015; 6:182-3. [PMID: 26312009 PMCID: PMC4544147 DOI: 10.4103/0976-500x.162054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jayanthi Mathaiyan
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pillaiyarkuppam, Puducherry, India
| | - Tanvi Jain
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pillaiyarkuppam, Puducherry, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pillaiyarkuppam, Puducherry, India
| | - K Satyanarayana Reddy
- Department of Radiation Oncology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India
| | - Gitanjali Batmanabane
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pillaiyarkuppam, Puducherry, India
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Bruscolini F, Paolucci D, Rosini V, Sabatini L, Andreozzi E, Pianetti A. Evaluation of ultraviolet irradiation efficacy in an automated system for the aseptic compounding using challenge test. Int J Qual Health Care 2015; 27:412-7. [DOI: 10.1093/intqhc/mzv051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 12/29/2022] Open
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Mathaiyan J, Jain T, Dubashi B, Reddy KS, Batmanabane G. Prescription errors in cancer chemotherapy: Omissions supersede potentially harmful errors. J Pharmacol Pharmacother 2015; 6:83-7. [PMID: 25969654 PMCID: PMC4419253 DOI: 10.4103/0976-500x.155484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/17/2014] [Accepted: 11/15/2014] [Indexed: 11/23/2022] Open
Abstract
Objective: To estimate the frequency and type of prescription errors in patients receiving cancer chemotherapy. Settings and Design: We conducted a cross-sectional study at the day care unit of the Regional Cancer Centre (RCC) of a tertiary care hospital in South India. Materials and Methods: All prescriptions written during July to September 2013 for patients attending the out-patient department of the RCC to be treated at the day care center were included in this study. The prescriptions were analyzed for omission of standard information, usage of brand names, abbreviations and legibility. The errors were further classified into potentially harmful ones and not harmful based on the likelihood of resulting in harm to the patient. Descriptive analysis was performed to estimate the frequency of prescription errors and expressed as total number of errors and percentage. Results: A total of 4253 prescribing errors were found in 1500 prescriptions (283.5%), of which 47.1% were due to omissions like name, age and diagnosis and 22.5% were due to usage of brand names. Abbreviations of pre-medications and anticancer drugs accounted for 29.2% of the errors. Potentially harmful errors that were likely to result in serious consequences to the patient were estimated to be 11.7%. Conclusions: Most of the errors intercepted in our study are due to a high patient load and inattention of the prescribers to omissions in prescription. Redesigning prescription forms and sensitizing prescribers to the importance of writing prescriptions without errors may help in reducing errors to a large extent.
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Affiliation(s)
- Jayanthi Mathaiyan
- Department of Pharmacology, Regional Cancer Centre, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Tanvi Jain
- Department of Pharmacology, Regional Cancer Centre, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Biswajit Dubashi
- Department of Medical Oncology, Regional Cancer Centre, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - K Satyanarayana Reddy
- Department of Radiotherapy, Regional Cancer Centre, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) ; Department of Radiation Oncology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Gitanjali Batmanabane
- Department of Pharmacology, Regional Cancer Centre, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Mattsson TO, Holm B, Michelsen H, Knudsen JL, Brixen K, Herrstedt J. Non-intercepted dose errors in prescribing anti-neoplastic treatment: a prospective, comparative cohort study. Ann Oncol 2015; 26:981-986. [PMID: 25632069 DOI: 10.1093/annonc/mdv032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/19/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The incidence of non-intercepted prescription errors and the risk factors involved, including the impact of computerised order entry (CPOE) systems on such errors, are unknown. Our objective was to determine the incidence, type, severity, and related risk factors of non-intercepted prescription dose errors. PATIENTS AND METHODS A prospective, comparative cohort study in two clinical oncology units. One institution used a CPOE system with no connection to the electronic patient record system, while the other used paper-based prescription forms. All standard prescriptions were included and reviewed. Doses were recalculated according to the guidelines of each institution, using the patient data as documented in the patient record, the paper-based prescription form, or the CPOE system. A non-intercepted prescription dose error was defined as ≥10% difference between the administered and the recalculated dose. RESULTS Data were collected from 1 November 2012 to 15 January 2013. A total of 5767 prescriptions were evaluated, 2677 from the institution using CPOE and 3090 from the institution with paper-based prescription. Crude analysis showed an overall risk of a prescription dose error of 1.73 per 100 prescriptions. CPOE resulted in 1.60 and paper-based prescription forms in 1.84 errors per 100 prescriptions, i.e. odds ratio (OR) = 0.87 [95% confidence interval (CI) 0.59-1.29, P = 0.49]. Fifteen different types of errors and four potential risk factors were identified. None of the dose errors resulted in the death of the patient. CONCLUSIONS Non-intercepted prescribing dose errors occurred in <2% of the prescriptions. The parallel CPOE system did not significantly reduce the overall risk of dose errors, and although it reduced the risk of calculation errors, it introduced other errors. Strategies to prevent future prescription errors could usefully focus on integrated computerised systems that can aid dose calculations and reduce transcription errors between databases.
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Affiliation(s)
- T O Mattsson
- Department of Oncology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense.
| | - B Holm
- Department of Oncology, Herlev Hospital, Copenhagen
| | - H Michelsen
- Department of Oncology, Herlev Hospital, Copenhagen
| | | | - K Brixen
- Department of Clinical Research, University of Southern Denmark, Odense; Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - J Herrstedt
- Department of Oncology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense
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Vantard N, Ranchon F, Schwiertz V, Gourc C, Gauthier N, Guedat MG, He S, Kiouris E, Alloux C, You B, Souquet PJ, Freyer G, Salles G, Trillet-Lenoir V, Rioufol C. EPICC study: evaluation of pharmaceutical intervention in cancer care. J Clin Pharm Ther 2015; 40:196-203. [DOI: 10.1111/jcpt.12242] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 12/18/2014] [Indexed: 11/30/2022]
Affiliation(s)
- N. Vantard
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - F. Ranchon
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
- EMR 3738; Université Lyon 1; Lyon France
| | - V. Schwiertz
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - C. Gourc
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - N. Gauthier
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - M.-G. Guedat
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - S. He
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - E. Kiouris
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - C. Alloux
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - B. You
- EMR 3738; Université Lyon 1; Lyon France
- Department of Oncology; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - P.-J. Souquet
- Department of Pneumology; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - G. Freyer
- EMR 3738; Université Lyon 1; Lyon France
- Department of Oncology; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - G. Salles
- Department of Haematology; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
- UMR 5239; Université Lyon 1; Lyon France
| | - V. Trillet-Lenoir
- Department of Oncology; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
| | - C. Rioufol
- Clinical Oncology Pharmacy Department; Hospices Civils de Lyon; Groupement Hospitalier Sud; Pierre Bénite France
- EMR 3738; Université Lyon 1; Lyon France
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71
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Masini C, Nanni O, Antaridi S, Gallegati D, Marri M, Paolucci D, Minguzzi M, Altini M. Automated preparation of chemotherapy: quality improvement and economic sustainability. Am J Health Syst Pharm 2014; 71:579-85. [PMID: 24644118 DOI: 10.2146/ajhp130489] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The quality and economic implications of manual versus automated preparation of antineoplastic drugs were compared. METHODS This four-week study evaluated 10 routinely used antineoplastic drugs (fluorouracil, cyclophosphamide, gemcitabine, trastuzumab, bevacizumab, oxaliplatin, cisplatin, paclitaxel, irinotecan, and etoposide) prepared by manual and automated procedures. The accuracy of the dose of the active ingredient was calculated in terms of percent relative error for the difference between the nominal value indicated on the prescription and the actual value of the drug in the finished product. A comparative economic analysis of the manual and automated preparation procedures was performed by calculating the mean unit cost for each preparation at different production levels. Participating pharmacists and technicians completed a survey rating each preparation method in terms of performance, operator satisfaction, technology, and safety. RESULTS Of the 2500 i.v. antineoplastic preparations made in the pharmacy during the four-week study period, 681 were analyzed (348 using the automated procedure and 333 manually). Of these, 17 varied by more than 5% of the prescribed dose, and 1 varied by over 10%. Accuracy, calculated in terms of average percent relative error, was the highest and lowest during manual preparation. The preparation time for individual drugs was always higher when prepared using the automated procedure. A lower mean variable unit cost was observed for preparations made using the automated procedure. Questionnaire results revealed that operators preferred the automated procedure over the manual procedure. CONCLUSION Both the automated and manual procedures for preparing antineoplastic preparations proved to be accurate and precise. The automated procedure resulted in substantial advantages in terms of quality maintenance standards and risk lowering.
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Affiliation(s)
- Carla Masini
- Carla Masini, B.Pharm., is Senior Oncology Pharmacist, Laboratory of Oncology Pharmacy; Oriana Nanni, M.Stat, is Director, Unit of Biostatistics and Clinical Trials; Sara Antaridi, B.Pharm., is Pharmacist, Laboratory of Oncology Pharmacy; Davide Gallegati, B.Econ., is Cost Controller, Finance and Management Control; and Mattia Marri, B.Sc., is Data Manager, Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRST IRCCS), Meldola, Italy. Demis Paolucci, Ph.D., is Scientific Manager, Loccioni Humancare, Moie di Maiolati, Ancona, Italy. Martina Minguzzi, B.Pharm., is Director, Oncology Pharmacy; and Mattia Altini, M.D., is Healthcare Director, Healthcare Management, IRST IRCCS
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72
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Sarfati L, Ranchon F, Vantard N, Schwiertz V, Gauthier N, He S, Kiouris E, Gourc-Berthod C, Guédat MG, Alloux C, Gustin MP, You B, Trillet-Lenoir V, Freyer G, Rioufol C. SIMMEON-Prep study: SIMulation of Medication Errors in ONcology: prevention of antineoplastic preparation errors. J Clin Pharm Ther 2014; 40:55-62. [DOI: 10.1111/jcpt.12225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- L. Sarfati
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - F. Ranchon
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
- Université Lyon 1, EMR UCBL/HCL 3738; Lyon France
| | - N. Vantard
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - V. Schwiertz
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - N. Gauthier
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - S. He
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - E. Kiouris
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - C. Gourc-Berthod
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - M. G. Guédat
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - C. Alloux
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - M.-P. Gustin
- Département de santé publique; Faculté de Pharmacie; Université Lyon 1; Lyon France
- Hôpital Nord-Ouest Villefranche-sur-Saône; Lyon France
- Hospices Civils de Lyon; Service de Biostatistique; Lyon France
| | - B. You
- Université Lyon 1, EMR UCBL/HCL 3738; Lyon France
- Medical Oncology Department; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Lyon France
| | - V. Trillet-Lenoir
- Université Lyon 1, EMR UCBL/HCL 3738; Lyon France
- Medical Oncology Department; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Lyon France
| | - G. Freyer
- Université Lyon 1, EMR UCBL/HCL 3738; Lyon France
- Medical Oncology Department; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Lyon France
| | - C. Rioufol
- Clinical Oncology Pharmacy Unit; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre Bénite France
- Université Lyon 1, EMR UCBL/HCL 3738; Lyon France
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73
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Ranchon F, You B, Salles G, Vantard N, Schwiertz V, Gourc C, Gauthier N, Guédat MG, Souquet PJ, Freyer G, Trillet-Lenoir V, Rioufol C. Improving cancer patient care with combined medication error reviews and morbidity and mortality conferences. Chemotherapy 2014; 59:330-7. [PMID: 24801809 DOI: 10.1159/000358190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 12/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND To reduce the occurrence of medication errors, a systemic approach was developed combining anti-neoplastic medication error reviews and morbidity and mortality conferences (M&MCs). We report the first experience of implementing this strategy in oncology. METHODS The case reports submitted to combined reviews were prepared by physicians and pharmacists, and medication error(s) were described and chronological and root-cause analyses were performed. RESULTS Ten combined reviews were conducted, which involved the departments of haematology, medical oncology, pneumology, gastroenterology and clinical oncology pharmacy. A total of 91 errors were analysed, of which 3 had reached the patient. Thirty-four corrective actions were proposed; 53% consisted of changes in practice, 35% in procedural reminders and 12% in on-ward education sessions. CONCLUSIONS The combination of medication error reviews and M&MCs appears to be an efficient means of improving cancer patient safety and personnel proficiency. This multidisciplinary work is indispensable to improve future patient management through the critical analysis of past medical errors.
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Affiliation(s)
- Florence Ranchon
- Department of Clinical Oncology Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
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74
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Aita M, Belvedere O, De Carlo E, Deroma L, De Pauli F, Gurrieri L, Denaro A, Zanier L, Fasola G. Chemotherapy prescribing errors: an observational study on the role of information technology and computerized physician order entry systems. BMC Health Serv Res 2013; 13:522. [PMID: 24344973 PMCID: PMC3878514 DOI: 10.1186/1472-6963-13-522] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used. METHODS Up to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale. RESULTS Eight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome. CONCLUSIONS Chemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.
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Affiliation(s)
- Marianna Aita
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Ornella Belvedere
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
- Department of Oncology, York Teaching Hospital, York, UK
| | - Elisa De Carlo
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Laura Deroma
- Regional Coordinator Centre for Rare Diseases, University Hospital of Udine, Udine, Italy
| | - Federica De Pauli
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Lorena Gurrieri
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
| | - Angela Denaro
- Department of Medical Oncology, University Hospital of Trieste, Trieste, Italy
| | - Loris Zanier
- Health Directorate, Friuli Venezia-Giulia Region, Trieste, Italy
| | - Gianpiero Fasola
- Department of Oncology, S. Maria della Misericordia, University Hospital, Udine, Italy
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75
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Elsaid K, Truong T, Monckeberg M, McCarthy H, Butera J, Collins C. Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis. Int J Qual Health Care 2013; 25:656-63. [PMID: 24132956 DOI: 10.1093/intqhc/mzt067] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the impact of electronic standardized chemotherapy templates on incidence and types of prescribing errors. DESIGN A quasi-experimental interrupted time series with segmented regression. SETTING A 700-bed multidisciplinary tertiary care hospital with an ambulatory cancer center. PARTICIPANTS A multidisciplinary team including oncology physicians, nurses, pharmacists and information technologists. INTERVENTION(S) Standardized, regimen-specific, chemotherapy prescribing forms were developed and implemented over a 32-month period. MAIN OUTCOME MEASURE(S) Trend of monthly prevented prescribing errors per 1000 chemotherapy doses during the pre-implementation phase (30 months), immediate change in the error rate from pre-implementation to implementation and trend of errors during the implementation phase. Errors were analyzed according to their types: errors in communication or transcription, errors in dosing calculation and errors in regimen frequency or treatment duration. Relative risk (RR) of errors in the post-implementation phase (28 months) compared with the pre-implementation phase was computed with 95% confidence interval (CI). RESULTS Baseline monthly error rate was stable with 16.7 prevented errors per 1000 chemotherapy doses. A 30% reduction in prescribing errors was observed with initiating the intervention. With implementation, a negative change in the slope of prescribing errors was observed (coefficient = -0.338; 95% CI: -0.612 to -0.064). The estimated RR of transcription errors was 0.74; 95% CI (0.59-0.92). The estimated RR of dosing calculation errors was 0.06; 95% CI (0.03-0.10). The estimated RR of chemotherapy frequency/duration errors was 0.51; 95% CI (0.42-0.62). CONCLUSIONS Implementing standardized chemotherapy-prescribing templates significantly reduced all types of prescribing errors and improved chemotherapy safety.
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Affiliation(s)
- K Elsaid
- Department of Pharmaceutical Sciences, MCPHS University, 179 Longwood Ave, Boston, MA 02115, USA.
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76
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Cho E, Kim HJ, Kim GM, Kum J, Chung HK, Lyu CJ, Ahn JB, Shin SJ. Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. Int J Med Inform 2013; 82:504-13. [PMID: 23481407 DOI: 10.1016/j.ijmedinf.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess whether the newly developed Comprehensive Chemotherapy Assistance Program (CAP) decreases errors and increases performance efficiency in ordering oncology medications as compared to the existing Computerized Physician Order Entry (CPOE) system, the Order Communication System (OCS). METHODS All chemotherapy prescriptions ordered using OCS and CAP systems during the first year of CAP implementation were prospectively analyzed to identify near-miss cases. The efficiency outcomes were determined in a trial setting with eight predefined hypothetical chemotherapy regimens, each with four measures of the average time, movement distance on the screen, maximum input interval time, and number of mouse or keystrokes per order. A total of 14 physicians participated in the study, and each regimen was ordered twice, once using CAP and once using OCS. RESULTS For all near-miss types, CAP orders showed significant improvements as compared with OCS orders (p<0.0001). For CAP orders, incorrect dose and agent errors were reduced by 43.9% and 31.6%, respectively. Compared with OCS orders, regimen defects, drug omissions, and incorrect data input errors were reduced by more than 70% for CAP orders. For all four efficiency measures, a statistically significant competence was identified when physicians ordered a chemotherapy prescription with CAP as compared with OCS (p<0.0001). CONCLUSIONS These results demonstrate the superiority of CAP over the existing CPOE system for ordering oncology medications with regard to safety and efficiency.
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Affiliation(s)
- Eun Cho
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
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Bruce K, Hall L, Castelo S, Evans M, Frangoul H. Direct provider feedback to decrease chemotherapy ordering errors: the "gray envelope" initiative. Pediatr Blood Cancer 2012; 59:1330-1. [PMID: 22692982 DOI: 10.1002/pbc.24224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/14/2012] [Indexed: 11/08/2022]
Abstract
Chemotherapy errors are the second leading cause of mortality related to medication errors. Most medication errors occur in the provider ordering process. We evaluated the rate of chemotherapy ordering errors in our center and designed an intervention to decrease the rate of ordering errors. The intervention focused on direct confidential written feedback to the providers. Our intervention resulted in a significant decrease in ordering errors from 7% pre-intervention to 3.9% post intervention (P < 0.001). We conclude that direct written provider feedback can result in a significant decrease in chemotherapy ordering errors.
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Affiliation(s)
- Katie Bruce
- Department of Pharmacy, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232-6310, USA
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Seger AC, Churchill WW, Keohane CA, Belisle CD, Wong ST, Sylvester KW, Chesnick MA, Burdick E, Wien MF, Cotugno MC, Bates DW, Rothschild JM. Impact of robotic antineoplastic preparation on safety, workflow, and costs. J Oncol Pract 2012; 8:344-9, 1 p following 349. [PMID: 23598843 DOI: 10.1200/jop.2012.000600] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Antineoplastic preparation presents unique safety concerns and consumes significant pharmacy staff time and costs. Robotic antineoplastic and adjuvant medication compounding may provide incremental safety and efficiency advantages compared with standard pharmacy practices. METHODS We conducted a direct observation trial in an academic medical center pharmacy to compare the effects of usual/manual antineoplastic and adjuvant drug preparation (baseline period) with robotic preparation (intervention period). The primary outcomes were serious medication errors and staff safety events with the potential for harm of patients and staff, respectively. Secondary outcomes included medication accuracy determined by gravimetric techniques, medication preparation time, and the costs of both ancillary materials used during drug preparation and personnel time. RESULTS Among 1,421 and 972 observed medication preparations, we found nine (0.7%) and seven (0.7%) serious medication errors (P = .8) and 73 (5.1%) and 28 (2.9%) staff safety events (P = .007) in the baseline and intervention periods, respectively. Drugs failed accuracy measurements in 12.5% (23 of 184) and 0.9% (one of 110) of preparations in the baseline and intervention periods, respectively (P < .001). Mean drug preparation time increased by 47% when using the robot (P = .009). Labor costs were similar in both study periods, although the ancillary material costs decreased by 56% in the intervention period (P < .001). CONCLUSION Although robotically prepared antineoplastic and adjuvant medications did not reduce serious medication errors, both staff safety and accuracy of medication preparation were improved significantly. Future studies are necessary to address the overall cost effectiveness of these robotic implementations.
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Affiliation(s)
- Andrew C Seger
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02120-1613, USA
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79
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Ranchon F, Moch C, You B, Salles G, Schwiertz V, Vantard N, Franchon E, Dussart C, Henin E, Colomban O, Girard P, Freyer G, Rioufol C. Predictors of prescription errors involving anticancer chemotherapy agents. Eur J Cancer 2012; 48:1192-9. [DOI: 10.1016/j.ejca.2011.12.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 12/29/2011] [Indexed: 11/15/2022]
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Russett F. Recent Publications on Medications and Pharmacy. Hosp Pharm 2012. [DOI: 10.1310/hpj4702-156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
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Affiliation(s)
- Flint Russett
- Department of Pharmacy and Drug Information, St. Claire Regional Medical Center, Morehead, Kentucky
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