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At-Home Drug Errors May Harm Pediatric Cancer Patients

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Fully 47% of pediatric cancer patients were exposed to at least one medication error based on medical records, bottle checks, and direct observation by visiting nurses

I was diagnosed with a blood cancer in 1994. The studies below spoke to me because I was 34 when I was first diagnosed (AYA, not even pediatric) and my wife and I made some serious mistakes while administering some of my at-home drug therapies.

I wasn’t even a pediatric cancer patient. My wife gave me regular injections of Neupogen at home during my induction chemotherapy. We kept a bunch of little bottles of the stuff in the fridge. One day my oncology nurse gave me a blood test to check my white blood cell count. She freaked. I had too many white blood cells. Lots too many. Apparently we had lost count of how many Neupogen injections we were supposed to administer…

My white blood cell count returned to normal eventually. No harm, no foul I guess. But lots of kids aren’t so lucky.

 

Medication errors happen at home, at the hospital, with adults and with kids. The fact is that medication errors happen potentially with everyone, potentially everywhere. The solution is to be aware of the problem and to employ techniques to solve or reduce the risk of errors. Take notes or record your conversation with your kid’s oncologist. Watch the nurse if he/she comes to your house to give your patient his/her medication.

In short, be ever vigilant.

I am both a cancer survivor and cancer coach. If you have a cancer question, scroll down the page, post it and I will reply to you ASAP.

Thanks

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Medication errors in the home: a multisite study of children with cancer

“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…”

At-Home Drug Errors May Harm Kids with Cancer

“Missed doses, wrong doses, and other medication errors are rife among children with cancer who receive part of their treatment at home, with substantial potential for harm, a study showed…Fully 47% of children were exposed to at least one medication error based on medical records, bottle checks, and direct observation by visiting nurses…The rate of any kind of medication error was 70 per 100 patients, the group reported in the May issue of Pediatrics.

Other errors included missed doses either reported by parents or based on how much was left in the bottle.

Better communication about medication use between families and physicians might have prevented 36% of errors, the adjudicators suggested.

“Frequent changes in dose, which caused the bottle label to be outdated, were often a root cause of parent errors,” Walsh and colleagues noted.”

Preventing Medication Errors at Home

Medication errors occur at the hands of not only health care professionals but also of in-home patient caregivers or the patients themselves. This article explores the various causes for therapeutic errors in pediatric as well as elderly patients within their home settings. In addition, suggestions are provided on educating the patients and their caregivers on the prevention of medication errors.,,”

 

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