Development of a Policy and Procedure for Accidental Chemotherapy Overdose

Abstract

A policy regarding rapid response to chemotherapy overdoses was developed by the authors in an attempt to minimize morbidity and mortality. The parameters of a chemotherapy overdose were defined to promote early recognition of an overdose incident. Resources needed to guide potential therapeutic interventions and required monitoring were developed. The policy defines the immediate actions to be taken in the event of a chemotherapy overdose. The availability of a chemotherapy overdose policy provides an enhanced level of safety for patients by ensuring that appropriate treatment is initiated without delay. The development of the policy was in response to the reporting of a tragic error at another institution. Healthcare providers must recognize and address potential areas of vulnerability to maximize patient safety.

A Retrospective Evaluation of Chemotherapy Overdoses in Dogs and Cats

“…Finally, a widely accepted definition of an OD does not exist in human or veterinary medicine. The definition used here was modified from one suggested in human medicine ( 5 ). Although a 10% OD may be a conservative definition and not result in serious clinical signs, an error of that magnitude in drugs with a narrow margin of safety should be recognized and implies the need for improved vigilance and processes to prevent more severe AEs from occurring.…”

“…Adverse events were retrospectively reported by the submitting clinician according to the Veterinary Cooperative Oncology Group-common terminology criteria for adverse events v1.1 (26). A chemotherapy OD was based on a modified human definition and patients were included for analysis if dose administration was 10% over the intended dosage, or the chemotherapy was administered at a significantly shorter interval than was intended (5). The OD was reported as a ratio of administered drug to intended dosage (e.g., a dog that received 30 mg/m 2 of vinorelbine instead of the intended 15 mg/m 2 was classified as a 2x OD).…”

“…The prevalence of chemotherapy errors in human medicine is not known as most published literature focuses on individual case reports and not encompassing cohort studies (4). Nevertheless, several agencies have attempted to decrease the probability of a chemotherapy OD by outlining standard practices to reduce the error rate (4,5). Single agent chemotherapy ODs have been reported with lomustine (6,7), oral and intrathecal methotrexate (8,9), cisplatin (10), and various vinca alkaloids (11)(12)(13), among others.…”

Learning From Disaster: Patient Safety and the Role of Oncology Nurses

“…Glenn can be reached at david.glenn@umaryland.edu, with copy to editor at CJONEditor@ons.org. Hospital, an interprofessional team of nurses, physicians, and pharmacists created new protocols for responding to accidental chemotherapy overdoses (Nelson, Moore, Grasso, Barbarotta, & Fischer, 2014). Not all patient safety challenges in oncology have to do with chemotherapy, of course.…”

Toxicity, outcome, and management of anthracycline overdoses in 16 dogs

“…Chemotherapy protocols are complex and commonly are given in a busy hospital environment, increasing the potential for errors. 1 In human medicine, computer order entry, improved infusion pump technologies, advanced IV workflow systems, specialty credentialing, and multiple double checks are instituted to help minimize possible errors. Despite these efforts, chemotherapy overdoses (ODs) still occur.…”