title: Medication safety of five oral chemotherapies: a proactive risk assessment.
abstract: OBJECTIVE
  Oral chemotherapies represent an emerging risk area in ambulatory oncology practice. To examine the hazards associated with five oral chemotherapies, we performed a proactive risk assessment.
  
  
  METHODS
  WE CONVENED INTERDISCIPLINARY TEAMS AND CONDUCTED FAILURE MODE AND EFFECTS ANALYSES (FMEAS) FOR FIVE ORAL CHEMOTHERAPY AGENTS: capecitabine, imatinib, temozolomide, 6-mercaptopurine, and an investigational agent. This involved the creation of process maps for each medication, identification of failure modes, selection of high-risk failure modes, and development of recommendations to mitigate these risks. We analyzed the number of steps and types of failure modes and compared this information across the study drugs.
  
  
  RESULTS
  Key vulnerabilities include patient education about drug handling and adverse effects, prescription writing, patient self-administration and medication adherence, and failure to monitor and manage toxicities. Many of these failure modes were common across the five oral chemotherapies, suggesting the presence of common targets for improvement. Streamlining the FMEA itself may promote the dissemination of this method.
  
  
  CONCLUSIONS
  Each stage of the medication process poses risks to the safe use of oral chemotherapies. FMEAs may identify opportunities to improve medication safety and reduce the risk of patient harm.
authors.affiliation: Center for Patient Safety, Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Saul N
authors.initials: SN
authors.lastname: Weingart
authors.forename: Justin
authors.initials: J
authors.lastname: Spencer
authors.forename: Stephanie
authors.initials: S
authors.lastname: Buia
authors.forename: Deborah
authors.initials: D
authors.lastname: Duncombe
authors.forename: Prabhjyot
authors.initials: P
authors.lastname: Singh
authors.forename: Mrinalini
authors.initials: M
authors.lastname: Gadkari
authors.forename: Maureen
authors.initials: M
authors.lastname: Connor