title: Medication errors in the home: a multisite study of children with cancer.
abstract: OBJECTIVE
  As home medication use increases, medications previously managed by nurses are now managed by patients and their families. Our objective was to describe the types of errors occurring in the home medication management of children with cancer.
  
  
  METHODS
  In a prospective observational study at 3 pediatric oncology clinics in the northeastern and southeastern United States, patients undergoing chemotherapy and their parents were recruited from November 2007 through April 2011. We reviewed medical records and checked prescription doses. A trained nurse visited the home, reviewed medication bottles, and observed administration. Two physicians independently made judgments regarding whether an error occurred and its severity. Overall rates of errors were weighted to account for clustering within sites.
  
  
  RESULTS
  We reviewed 963 medications and observed 242 medication administrations in the homes of 92 patients. We found 72 medication errors. Four errors led to significant patient injury. An additional 40 errors had potential for injury: 2 were life-threatening, 13 were serious, and 25 were significant. Error rates varied between study sites (40-121 errors per 100 patients); the weighted overall rate was 70.2 errors per 100 patients (95% confidence interval [CI]: 58.9-81.6). The weighted rate of errors with injury was 3.6 (95% CI: 1.7-5.5) per 100 patients and with potential to injure the patient was 36.3 (95% CI: 29.3-43.3) per 100 patients. Nonchemotherapy medications were more often involved in an error than chemotherapy.
  
  
  CONCLUSIONS
  Medication errors were common in this multisite study of outpatient pediatric cancer care. Rates of preventable medication-related injuries in this outpatient population were comparable or higher than those found in studies of hospitalized patients.
authors: Departments of Pediatrics, University of Massachusetts School of Medicine, Worcester, MA 01655, USA. walshk02@ummhc.org
authors: Kathleen E
authors: KE
authors: Walsh
authors: Douglas W
authors: DW
authors: Roblin
authors: Saul N
authors: SN
authors: Weingart
authors: Kathleen E
authors: KE
authors: Houlahan
authors: Barbara
authors: B
authors: Degar
authors: Amy
authors: A
authors: Billett
authors: Christopher
authors: C
authors: Keuker
authors: Colleen
authors: C
authors: Biggins
authors: Justin
authors: J
authors: Li
authors: Karen
authors: K
authors: Wasilewski
authors: Kathleen M
authors: KM
authors: Mazor
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003152:Community Health Nursing; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D005260:Female; D006701:Home Nursing; D006801:Humans; D015994:Incidence; D008297:Male; D020380:Needs Assessment; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D061214:Patient Safety; D011446:Prospective Studies; D018570:Risk Assessment; D014481:United States; D016903:Drug Monitoring
keywords: antineoplastic agents; medical errors; medication errors; patient safety; pediatric cancer; quality improvement
references: J Pediatr. 2005 Dec;147(6):761-7
references: 16356427
references: JAMA. 1995 Jul 5;274(1):29-34
references: 7791255
references: Arch Pediatr Adolesc Med. 2010 Feb;164(2):181-6
references: 20124148
references: Am J Health Syst Pharm. 2002 Mar 1;59(5):436-46
references: 11887410
references: Pediatr Crit Care Med. 2007 Mar;8(2):145-52
references: 17273111
references: Cancer. 2006 Sep 15;107(6):1400-6
references: 16909415
references: Am J Health Syst Pharm. 2001 Jan 1;58(1):54-9
references: 11194136
references: BMC Health Serv Res. 2004 Dec 15;4(1):35
references: 15601473
references: N Engl J Med. 1991 Feb 7;324(6):377-84
references: 1824793
references: Lancet. 1979 Jun 9;1(8128):1250-1
references: 87722
references: N Engl J Med. 2004 Oct 28;351(18):1838-48
references: 15509817
references: Pediatrics. 2003 Apr;111(4 Pt 1):722-9
references: 12671103
references: Pediatrics. 2008 Nov;122(5):e1053-61
references: 18977954
references: Ambul Pediatr. 2007 Sep-Oct;7(5):383-9
references: 17870647
references: Arch Dis Child. 2011 Jun;96(6):581-6
references: 21444297
references: Cancer. 1986 Sep 1;58(5):1179-84
references: 3731045
references: Am J Hosp Pharm. 1982 Nov;39(11):1881-7
references: 6756133
references: NCHS Data Brief. 2010 Sep;(42):1-8
references: 20854747
references: N Engl J Med. 2003 Apr 17;348(16):1556-64
references: 12700376
references: Pediatrics. 1997 Sep;100(3 Pt 1):330-3
references: 9282701
references: JAMA. 2006 Oct 18;296(15):1858-66
references: 17047216
references: BMC Fam Pract. 2006 Mar 24;7:21
references: 16563164
references: J Oncol Pract. 2013 Jan;9(1):e1-7
references: 23633976
references: Pediatr Emerg Care. 2000 Dec;16(6):394-7
references: 11138879
references: Patient Educ Couns. 1999 Sep;38(1):33-42
references: 14528569
references: J Pediatr. 2008 Mar;152(3):416-21
references: 18280852
references: Pediatrics. 2006 Nov;118(5):1872-9
references: 17079557
references: BMJ. 2005 Feb 5;330(7486):293
references: 15665005
references: JAMA. 2001 Apr 25;285(16):2114-20
references: 11311101
references: Cancer. 2005 Dec 1;104(11):2477-83
references: 16245353
references: JAMA. 2003 Mar 5;289(9):1107-16
references: 12622580
references: J Clin Oncol. 2009 Feb 20;27(6):891-6
references: 19114695
references: J Oncol Pract. 2011 Jan;7(1):2-6
references: 21532801
references: Diabetes Care. 2009 Feb;32(2):234-9
references: 19017773
references: JAMA. 2008 Jun 25;299(24):2857-67
references: 18577730
references: CA Cancer J Clin. 2009 Jan-Feb;59(1):56-66
references: 19147869
references: BMJ. 2000 Dec 2;321(7273):1400-2
references: 11099288
references: Pediatrics. 2011 Mar;127(3):529-38
references: 21339266
references: Arch Pediatr Adolesc Med. 2003 Jan;157(1):60-5
references: 12517196