Cross-Sectional Study to Enhance the Prediction of Prescribing Errors for the Oncology Patients

Abstract

Medication error (ME) is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. In asystematic review study of medication errors in the Middle East countries it was found that 46 % of the medication errors occurred during the prescribing stage. Prescribing errors occur during chemotherapeutic agent treatment can lead to tragic toxicities because of higher vulnerability of patients, complex treatment regimens, intensive combinations, and narrow therapeutic index of drugs. When considering medication errors, antineoplastic drugs are the second most common cause of death, therefore numerous recommendations have been published in order to decrease the risk of errors. The prescribing errors causes could be because of mistakes due to inadequate knowledge of the drug or the patient, in addition to skills-based slips and memory lapses, in addition to lack of training or experience, fatigue, stress, high workload for the prescriber and inadequate communication between healthcare professionals. Computerized tools, educational strategies, expanding professional roles, and risk factors study could decrease and prevent the prescribing errors incidence. Several studies have addressed prescribing errors in the oncology service; On the contrary few studies have evaluated the effect of studying factors leading to chemotherapy- related prescribing errors. Our study aimed to identify the incidence, scientific evidence and severity of prescribing errors, as well as identifying predictors of prescribing errors in the oncology department, through examining the impact of some risk factors on the errors incidence. This study is a cross-sectional observational study examining a random sample of out-patients, with proven malignant disease receiving chemotherapy, over a period of 6 months on a biweekly selection basis from March 2014 till August 2014 who visit the chemotherapy central clinic, Oncology department, Ain Shams University Hospitals. In which a number of 500 patients were observed during the whole study. Prescription errors were twenty types classified according to their incidence, scientific evidence and severity; in addition the relation between the risk factors and the observed prescribing errors was studied. British Columbia Cancer Agency (BCCA) data base was used as a reference to identify the errors. The prescribing errors under study were as follows, unidentified protocol, inappropriate medications , medication omission, Body Surface Area (BSA) calculation error, dose error, dose omission, wrong dose time, potential drug-drug interactions, laboratory test omission prior to dose receiving, duplicate prescribing, omitted or improper route of administration of the chemotherapy, wrong infusion volume and rate of the diluent, improper follow up plan, illegible hand writing, protocol not signed, stage not specified, missed patient number, and finally the intention of treatment not complying with the protocol of choice. The impact of fourteen risk factors on prescribing errors was studied, because they can play central part in the prediction and prevention of prescribing errors.

The potential risk factors were grouped into 4 categories: 1- Patient related risk factors. 2- Health status related risk factors. 3- Tumor related risk factors. 4- Chemotherapy related risk factors.