The Pharmaceutical Journal
Vol 278 No 7455 p664
9 June 2007

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Most paediatric cancer drug errors reach patients before detection

Errors made when prescribing, preparing or administering paediatric cancer drugs often reach the patient before being detected, with methotrexate being the drug most commonly implicated, according to an epidemiological study published online in Cancer (25 May 2007).

The authors analysed data from a US national, voluntary error reporting system — with 616 participating hospitals rep — covering all error reports between 1999 and 2004 that involved chemotherapy medicines and patients under 18 years old.

The authors identified 310 paediatric chemotherapy error reports from 69 hospitals. A trend towards more error reports in larger institutions with a greater availability of pharmacists onsite 24 hours a day was observed.

A total of 85 per cent of the drug errors were not detected before reaching the patient and 15.6 per cent resulted in additional patient monitoring or therapeutic intervention. Five required treatment or prolonged hospital stays.

Only one of these occurred in a hospital that did not have an onsite pharmacist 24 hours a day, say the authors.

Overall, 55.2 per cent of errors occurred in inpatient units, 10 per cent in outpatient clinics and 34.8 per cent in unknown locations. Outpatient chemotherapy errors were more likely to involve dispensing mistakes, prescribing mistakes and equipment failures. Errors that occurred within pharmacies accounted for 20 per cent of those identified.

The most common error was in administering the drug (149 errors) with these often involving improper dosing, timing or omission. Dispensing errors were the next most commonly reported (94 errors).

The most common drug classes involved in errors were antimetabolites (39.5 per cent), alkylating agents (14 per cent) and anthracyclines (9.3 per cent). Methotrexate was the most commonly involved agent (15.3 per cent), followed by cytarabine (12.1 per cent), etoposide (8.3 per cent) and doxorubicin (6.2 per cent).

“ Paediatric hospitals and future quality improvement research should target medication administration safeguards for these high-risk medications and should consider different and specific solutions for inpatient and outpatient paediatric oncology units, respectively,” the authors conclude.