title: Chemotherapy safety and severe adverse events in cancer patients: strategies to efficiently avoid chemotherapy errors in in- and outpatient treatment.
abstract: To enhance the quality and safety in cancer treatment, and in acknowledgement that medical errors occur, we have established 2 error management systems: one monitors chemotherapy errors, the other records all severe adverse events occurring in chemotherapy-treated cancer patients (SAECTx) in in- and outpatient treatment. These error systems have been implemented by our departmental "Clinical Service Center," a multidisciplinary team which controls all chemotherapy protocols and orders prior to the medication reaching the patient. We performed a prospective cohort study in consecutive cancer patients who received chemotherapies in our department between January 2005 and December 2006. Over this 2-year period, 2,337 patients were treated, with an equal distribution as in- and outpatients: 22,216 consecutive chemotherapy orders were analyzed, of which 83.5% were completely flawless, whereas we detected and corrected medical and administrative errors in 17.1%: in 3.8%, these errors involved the chemotherapy itself, in 4.5% the patient data and in 8.7% missing written informed consent forms. Chemotherapy errors were less frequent in outpatients than inpatients (3.3 vs. 4.5%, respectively). In outpatients, the rate of chemotherapy errors decreased from 4% in 2005 to 2.8% in 2006, but remained stable for inpatients (4.4% 2005 vs. 4.7% 2006). Among a total of 3,792 detected errors, only 3 reached the patient, resulting in an error rate in patients of 0.079%. Therefore, since we detected a substantial number of chemotherapy-related errors and intercepted 99.9%, we recommend our efficient surveillance system as an important safety check, thereby ensuring that chemotherapies are delivered error-free to cancer patients.
authors.affiliation: Department of Hematology and Oncology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Markert
authors.forename: Véronique
authors.initials: V
authors.lastname: Thierry
authors.forename: Martina
authors.initials: M
authors.lastname: Kleber
authors.forename: Michael
authors.initials: M
authors.lastname: Behrens
authors.forename: Monika
authors.initials: M
authors.lastname: Engelhardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010045:Outpatients; D017751:Safety Management / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents