title: Medication errors among adults and children with cancer in the outpatient setting.
abstract: OBJECTIVE
  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 (kappa = 0.65), identified its severity (kappa = 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University of Massachusetts Medical Center, Benedict Second Floor, 55 North Lake St, Worcester, MA 01655, USA. walshk02@ummhc.org
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Walsh
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Dodd
authors.forename: Kala
authors.initials: K
authors.lastname: Seetharaman
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Roblin
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
authors.forename: Ann
authors.initials: A
authors.lastname: Von Worley
authors.forename: G Naheed
authors.initials: GN
authors.lastname: Usmani
authors.forename: David
authors.initials: D
authors.lastname: Baer
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D014481:United States