Medication Errors Common in Treatment of Children with Leukemia

NEW YORK AUG 18, 2006 (Reuters Health) - Approximately one in five children being cared for at home for acute lymphoblastic leukemia (ALL) may be subject to medication errors, according to an early report in the journal Cancer, published online on August 14. Although the errors encountered in the current study were mostly trivial, some could reduce treatment efficacy or increase toxicity to the patient.

Most information regarding medication errors comes from inpatient settings, lead investigator Dr. James A. Taylor and his team report.  They propose that medication errors may be even more common when administered by parents to their children, and capable of causing more damage when the patients are being treated for ALL.

The research team conducted a prospective case series study at the Children"s Hospital and Regional Medical Center in Seattle over a 2-month period in 2005.  The subjects were 69 children undergoing treatment during a first bout with the disease, and their caregivers.

Investigators asked caregivers to describe and demonstrate how medications were being given, and to tell when, how often and for how long each drug was used.

An oncologist reviewed patients" medical records to ensure that the correct treatment regimen at the right dose and at the right time was being prescribed.

Overall, 172 chemotherapeutic medications were administered.  At least one medication error occurred with 17 (9.9%).  Twelve were administration errors (by the caregiver) and five were prescribing errors (by the physician), involving 13 children (18.8%).

The risk of making medication errors among caregivers was not associated with ability to speak English, level of education, time since diagnosis or patient risk classification.

Three of the administration errors were incorrect dosing of chemotherapeutic agents, with an average difference of 15.4% between prescribed and administered dose.  The other caregiver errors were related to corticosteroid medications.

The prescribing errors involved miscalculated doses, with an average discrepancy of 22.0%.  However, one child was prescribed a 54.7% overdose of mercaptopurine, despite the patient having neutropenia.  Most errors were due to incorrectly determined dose based on weight or body surface area.

The authors note that most of the errors had little clinical significance.  However, three children had a higher risk of relapse, and one was placed at higher threat of infection.

Nevertheless, Dr. Taylor and his associates report, the results show that parents are as capable of administering oral chemotherapeutic agents as well as medical professionals, among whom previous research showed an even higher rate of errors.

They suggest changes to reduce the risk of errors, such as requiring two providers to cosign records regarding chemotherapy or computerization of records that include standardized dosing tables.

"In designing new protocols, a balance needs to be struck between the precision of dosing regimens and simplification so that medication errors are minimized," Dr. Taylor and his team conclude.

SOURCE:

• Cancer 2006.