Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: A multisite longitudinal assessment.

Autor: Wong CI; Pediatric Hematology-Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.; Medical Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA., Vannatta K; Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA.; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA., Gilleland Marchak J; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.; Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Quade EV; Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA., Rodgers IM; Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA., Reid CM; Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Dandoy CE; Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.; Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Billett AL; Quality and Safety Program, Nemours Children's Health, Delaware Valley, Wilmington, Delaware, USA., Miller TP; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.; Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA., Vaughn S; Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Daraiseh NM; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA., Liu S; Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, USA.; Institutional Centers for Clinical Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA., Carle AC; Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.; College of Medicine University of Cincinnati, Cincinnati, Ohio, USA.; Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio, USA., Walsh KE; Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2023 Apr 01; Vol. 129 (7), pp. 1064-1074. Date of Electronic Publication: 2023 Jan 27.
DOI: 10.1002/cncr.34651
Abstrakt: Background: There is little longitudinal information about the type and frequency of harm resulting from medication errors among outpatient children with cancer. We aimed to characterize rates and types of medication errors and harm to outpatient children with leukemia and lymphoma over 7 months of treatment.
Methods: We recruited children taking medications at home for leukemia or lymphoma from three pediatric cancer centers. Errors were identified by chart review, in-home medication review, observation of administration, and interviews. Physician reviewers confirmed error (Fleiss' κ = 0.95), harm (Fleiss' κ = 0.82), and suggested interventions. Generalized linear mixed models with random effects were used to account for clustering by site.
Results: Among 131 children taking 1669 medications with 367 home visits, 408 errors were identified, including 242 with potential for harm and 39 with harm (1.0 harm per 1000 patient-days [95% CI, 0.1-9.8]). Ten percent of children were injured by errors and 42% had errors with potential for harm. Twenty-six percent of caregivers reported that miscommunication led to missed doses or overdoses at home. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%).
Conclusions: In this longitudinal study, 10% children with leukemia or lymphoma experienced adverse drug events because of outpatient medication errors. Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering.
Plain Language Summary: In this longitudinal study, medication errors in the clinic, pharmacy, or at home among children with leukemia or lymphoma over a 7-month period were common, and 10% suffered harm because of errors. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%). Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering.
(© 2023 American Cancer Society.)
Databáze: MEDLINE
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