SEATTLE – Kids with leukemia who are treated as outpatients at Seattle Children’s Hospital and Regional Medical Center have about a one in five chance of being given the wrong medication or the wrong dosage, a study published today indicates.
Most of the mistakes the researchers found were trivial, although three could have – but did not – cause problems for the children, said the lead researcher, Dr. James Taylor, professor of pediatrics at the University of Washington Medical Center.
Taylor, who is director of the newborn nursery, said inspiration for the study came from the realization that although medication errors are one of the most common types of medical errors, little research has been done on children and especially on those being treated for cancer as outpatients.
Taylor said he was amazed at how well the doctors who prescribed treatment and the parents who administered the drugs did in the study.
“I thought it was going to be a lot higher, based on some other studies,” he said late last week.
Taylor’s study is being published in today’s issue of Cancer, a scientific journal published by the American Cancer Society.
The hospital’s self-study, conducted over a two-month period in 2005, involved children diagnosed with acute lymphoblastic leukemia, which is the most common malignancy diagnosed in children. About a third of all children with cancer have that form of the disease.
The study at Children’s Hospital, which is part of the University of Washington system, looked at each possible point for medication error: from the doctor’s prescription to the pharmacy to dosing by parents or caregivers. Taylor and his team found errors at every point along the way, except for the pharmacy, where no mistakes were made.
The study looked at 69 patients receiving 172 chemotherapy medications and found one or more errors involving 17 medications and an unconfirmed possibility of more errors in 12 more drugs. Among the 17 errors, 12 were administration errors and five were prescription errors. At least one medication error affected 13 of the 69 children studied, or 18.8 percent.
“The problem of medication errors among children receiving oral outpatient chemotherapy agents is particularly significant,” Taylor said in the report in Cancer. The medications are particularly toxic and have narrow therapeutic windows, so mistakes can be life-threatening.
During the two-month study, one medication error discovered had the potential for disastrous results, the report said. All the prescribing errors were miscalculated doses. The worst of these errors was a 57 percent overdose of a weekly medication.
Many of the errors were caused by parents mistaking the amount of a drug they were supposed to administer or giving drugs more often or less often than prescribed. The doctors conducting the study did not vilify the parents for these mistakes, expressing understanding instead.
“Although parents of children receiving outpatient oral chemotherapy may be highly invested in properly administering the prescribed drugs, the number of required medications and complexity of dosing may be challenging for parents without medical training,” Taylor and his colleagues wrote in their report.
“I think the parents did incredibly well,” he said. “The parents did about as well as health professionals have done in other studies.”
The authors of the study cautioned that the research was done with a modest sample size and may not indicate changes need to be made in all outpatient treatment programs for leukemia, but they did have some suggested improvements.
The doctors said most prescription miscalculations could be eliminated by requiring two doctor signatures on chemotherapy orders, as Children’s Hospital already requires for clinic and inpatient treatment.
They felt parents could be helped in getting the dosages correct if treatment was the same every day, and if drug makers would make different doses of pills in different colors and sizes.
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