When a pharmaceutical mixing error that was first noticed in March 2013 caused over a thousand Ontario cancer patients to receive the wrong dose of intravenous (IV) chemotherapy, an inquiry was launched. Results of the inquiry led to the establishment of new preventative measures; however, the scope of the inquiry and practice improvements were limited to preventing the errors associated with administering IV drugs. Thus, safety issues for drugs that are administered through other means were not addressed.
In a recent study on chemotherapy drug dispensing in Nova Scotia, Techna Affiliated Faculty Dr. Patricia Trbovich and Clinical Engineer Melissa Griffin found that administration of IV chemotherapy involves a total of 57 systematic checks to help prevent errors. Checks can include verifying information, such as a pharmacist verifying a patient's blood test results to ensure that they are eligible to receive treatment or looking up possible interactions with other medications. To be systematic, a 'check' must be clearly defined as part of a health care provider's role and be performed consistently.
Conversely, oral chemotherapy—which poses many of the same toxicity risks—has only six systematic and independent checks. For oral chemotherapy, which is typically dispensed in the community and administered in the home, a community pharmacist was the only qualified professional involved in independent systematic checks.
“There is an enormous opportunity for community pharmacists and other health care professionals to take on an expanded role in improving patient safety,” concludes Dr. Trbovich, who is working with Cancer Care Ontario to develop new guidelines for chemotherapy dispensing.
This work was supported by Cancer Care Nova Scotia and The Princess Margaret Cancer Foundation.
Comparison of independent error checks for oral versus intravenous chemotherapy. Griffin MC, Gilbert RE, Broadfield LH, Easty AE, Trbovich PL. Journal of Oncology Practice. 2015 Sep 29. [Pubmed abstract]