title: Implementation of safeguards to improve patient safety in chemotherapy.
abstract: OBJECTIVE
  To evaluate the effectiveness of safeguards introduced in the process of using cytostatic agents for increasing the safety of oncology patients.
  
  
  METHODS
  Prospective hospital study conducted in two stages, before and after the implementation of safeguards: staff training, standardized procedures, computerized prescription, pharmaceutical validation, implementation of bar codes, and a new manual on drug interactions. Medication errors (MEs) were actively recorded during the process of administering chemotherapy in the Medical Oncology Department. The study classified MEs by the stage of the medication process in which they occurred and assessed their severity.
  
  
  RESULTS
  500 patients, 250 before implementing safeguards and 250 afterward, were included in this study . Out of all patients included before, 43.1% had at least 1 error, compared to 27% of those included later. The number of MEs detected before and after was 144 vs. 95: 125 vs. 55 prescription errors, 2 vs. 5 validation errors, 14 vs. 4 preparation errors, 3 vs. 1 dispensation errors and 0 vs. 30 administration errors. The number of MEs that reached the patient before and after safeguard implementation was 16.7% vs. 6.3%. After the safeguards were introduced, all MEs that could have caused harm or required monitoring of some kind were prevented.
  
  
  CONCLUSIONS
  Implementing safeguards in the hospital's cytostatic treatment cycle is useful for preventing MEs. Computerized prescription, pharmaceutical validation, and the creation/dissemination of proper work procedures are effective barriers that keep MEs from reaching the patient. Administering chemotherapy with a bar-code system facilitates detection error detection at this stage of the cycle and prevents them from reaching the patient.
authors.affiliation: Clinical Pharmacy Management Unit, Puerta del Mar University Hospital, Avda. Ana de Viya 21, 11009, Cádiz, Spain. maijofarm@gmail.com.
authors.forename: M J
authors.identifier: http://orcid.org/0000-0002-0700-2872
authors.initials: MJ
authors.lastname: Huertas-Fernández
authors.affiliation: Clinical Pharmacy Management Unit, Puerta del Mar University Hospital, Avda. Ana de Viya 21, 11009, Cádiz, Spain.
authors.forename: Mª J
authors.initials: MJ
authors.lastname: Martínez-Bautista
authors.affiliation: Clinical Pharmacy Management Unit, Puerta del Mar University Hospital, Avda. Ana de Viya 21, 11009, Cádiz, Spain.
authors.forename: M E
authors.initials: ME
authors.lastname: Rodríguez-Mateos
authors.affiliation: Preventive Medicine Department, Puerta del Mar University Hospital, Cádiz, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Zarzuela-Ramírez
authors.affiliation: Medical Oncology Department, Puerta del Mar University Hospital, Cádiz, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Muñoz-Lucero
authors.affiliation: Medical Oncology Department, Puerta del Mar University Hospital, Cádiz, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Baena-Cañada
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D061214:Patient Safety / Q000592:standards*; D011446:Prospective Studies; D013030:Spain
chemical_list: D000970:Antineoplastic Agents
keywords: Adverse drug events; Bar-code medication administration system; Chemotherapy; Cytostatic agents; Medication errors