title: Multisite parent-centered risk assessment to reduce pediatric oral chemotherapy errors.
abstract: OBJECTIVE
  Observational studies describe high rates of errors in home oral chemotherapy use in children. In hospitals, proactive risk assessment methods help front-line health care workers develop error prevention strategies. Our objective was to engage parents of children with cancer in a multisite study using proactive risk assessment methods to identify how errors occur at home and propose risk reduction strategies.
  
  
  METHODS
  We recruited parents from three outpatient pediatric oncology clinics in the northeast and southeast United States to participate in failure mode and effects analyses (FMEA). An FMEA is a systematic team-based proactive risk assessment approach in understanding ways a process can fail and develop prevention strategies. Steps included diagram the process, brainstorm and prioritize failure modes (places where things go wrong), and propose risk reduction strategies. We focused on home oral chemotherapy administration after a change in dose because prior studies identified this area as high risk.
  
  
  RESULTS
  Parent teams consisted of four parents at two of the sites and 10 at the third. Parents developed a 13-step process map, with two to 19 failure modes per step. The highest priority failure modes included miscommunication when receiving instructions from the clinician (caused by conflicting instructions or parent lapses) and unsafe chemotherapy handling at home. Recommended risk assessment strategies included novel uses of technology to improve parent access to information, clinicians, and other parents while at home.
  
  
  CONCLUSIONS
  Parents of pediatric oncology patients readily participated in a proactive risk assessment method, identifying processes that pose a risk for medication errors involving home oral chemotherapy.
authors: University of Massachusetts School of Medicine, USA. Kathleen.Walsh2@umassmemorial.org
authors: Kathleen E
authors: KE
authors: Walsh
authors: Kathleen M
authors: KM
authors: Mazor
authors: Douglas
authors: D
authors: Roblin
authors: Colleen
authors: C
authors: Biggins
authors: Joann L
authors: JL
authors: Wagner
authors: Kathleen
authors: K
authors: Houlahan
authors: Justin W
authors: JW
authors: Li
authors: Christopher
authors: C
authors: Keuker
authors: Karen
authors: K
authors: Wasilewski-Masker
authors: Jennifer
authors: J
authors: Donovan
authors: Abir
authors: A
authors: Kanaan
authors: Saul N
authors: SN
authors: Weingart
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002648:Child; D005260:Female; D058015:Health Communication; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy*; D010290:Parents; D018570:Risk Assessment; D014481:United States
chemical_list: D000970:Antineoplastic Agents
references: Arch Dis Child. 2011 Jun;96(6):581-6
references: 21444297
references: Int J Radiat Oncol Biol Phys. 2008;71(1 Suppl):S187-90
references: 18406925
references: Qual Saf Health Care. 2003 Dec;12 Suppl 2:ii33-8
references: 14645893
references: Jt Comm J Qual Improv. 2002 May;28(5):248-67, 209
references: 12053459
references: Cancer. 2006 Sep 15;107(6):1400-6
references: 16909415
references: Pediatrics. 2008 Aug;122(2):e305-17
references: 18676516
references: J Natl Cancer Inst. 2002 May 1;94(9):652-61
references: 11983753
references: An Pediatr (Barc). 2004 Feb;60(2):177-9
references: 14757024
references: J Gen Intern Med. 2007 Jan;22(1):6-12
references: 17351835
references: Arch Intern Med. 2005 Jan 24;165(2):234-40
references: 15668373
references: Diabetes Technol Ther. 2005 Oct;7(5):710-8; discussion 719-20
references: 16241873
references: Qual Saf Health Care. 2004 Jun;13(3):206-12
references: 15175492
references: Pediatrics. 2003 Aug;112(2):431-6
references: 12897304
references: J Clin Oncol. 1996 Dec;14(12):3148-55
references: 8955661
references: BMJ Qual Saf. 2011 May;20(5):397-401
references: 21300991
references: Cancer. 2005 Dec 1;104(11):2477-83
references: 16245353
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: J Natl Compr Canc Netw. 2008 Mar;6 Suppl 3:S1-14
references: 18377852
references: Clin Pediatr (Phila). 1970 Nov;9(11):648-51
references: 5477275
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