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1/6/2003

Safety of Cancer Drug Use Improves

Cheryl A. Thompson

Efforts to improve the safety of cancer chemotherapy in hospitals may be bearing fruit. For the first time, no oncology agent appeared among the 10 drugs most frequently mentioned in reports of medications errors anonymously submitted to the United States Pharmacopeia (USP).

A summary of the 105,603 reports amassed in 2001 by USP’s MedMARx medication-error database was released last month. The results for 2001, with 368 hospitals participating, in many ways confirm the two previous annual reports, for which far fewer facilities submitted data (see July 1, 2002, AJHP News). An exception to the previous findings is the change in the notorious top 10 list.

The progress made in preventing harmful errors with the use of cancer drugs may be due to hospitals banning oral orders for these products and using preprinted order forms, said Diane D. Cousins, vice president of the USP Center for the Advancement of Patient Safety, which analyzes the MedMARx data. Preprinted order forms, she explained, provide guidance on appropriate dosages and all but eliminate problems deciphering prescribers’ handwriting.

Cousins reviewed the 40-page "Summary of Information Submitted to MedMARx in the Year 2001: A Human Factors Approach to Understanding Medication Errors" during a USP-convened press conference.

Insulins, morphine, and heparin retained their positions as the three drugs most frequently associated with harmful errors. Coming in fourth through tenth were warfarin, potassium chloride, furosemide, vancomycin, hydromorphone, meperidine, and diltiazem, respectively. USP grouped all formulations and dosage forms of a drug together. For example, errors involving concentrated solutions of potassium chloride were grouped with those of premixed i.v. solutions containing potassium chloride.

Progress in decreasing errors with "high-alert" medication—drugs that, when used incorrectly, have a high risk of killing the patient or causing serious harm—is evident in the literature, said Cousins. Authors have described in AJHP, for example, their hospitals’ implementation of a standardized order set and technology to create a double-check system.

"Once they’re aware of where [in the medication-use process] these errors occur with high-alert medications, they’re ensuring things like reduction of verbal orders," she said, a change that can decrease the occurrence of errors during the documentation process. Practitioners are also removing high-risk, high-alert medications from floor stock and automated dispensing machines on patient care units.

Roger L. Williams, USP executive vice president, said the MedMARx program’s goal is to help hospitals eliminate all fatal medication errors.

Fourteen error-related deaths from 12 drugs were reported to MedMARx in 2001. Seven of these drugs were high-alert medications: cocaine, digoxin, doxorubicin, heparin, meperidine, morphine, and potassium phosphates.