Medication Errors in the Home: A Multisite Study of Children With Cancer

Abstract

OBJECTIVE: As home medication use increases, medications previously managed by nurses are now managed by patients and their families. Our objective was to describe the types of errors occurring in the home medication management of children with cancer. METHODS: In a prospective observational study at 3 pediatric oncology clinics in the northeastern and southeastern United States, patients undergoing chemotherapy and their parents were recruited from November 2007 through April 2011. We reviewed medical records and checked prescription doses. A trained nurse visited the home, reviewed medication bottles, and observed administration. Two physicians independently made judgments regarding whether an error occurred and its severity. Overall rates of errors were weighted to account for clustering within sites. RESULTS: We reviewed 963 medications and observed 242 medication administrations in the homes of 92 patients. We found 72 medication errors. Four errors led to significant patient injury. An additional 40 errors had potential for injury: 2 were life-threatening, 13 were serious, and 25 were significant. Error rates varied between study sites (40–121 errors per 100 patients); the weighted overall rate was 70.2 errors per 100 patients (95% confidence interval [CI]: 58.9–81.6). The weighted rate of errors with injury was 3.6 (95% CI: 1.7–5.5) per 100 patients and with potential to injure the patient was 36.3 (95% CI: 29.3–43.3) per 100 patients. Nonchemotherapy medications were more often involved in an error than chemotherapy. CONCLUSIONS: Medication errors were common in this multisite study of outpatient pediatric cancer care. Rates of preventable medication-related injuries in this outpatient population were comparable or higher than those found in studies of hospitalized patients.

Home Medication Support for Childhood Cancer: Family-Centered Design and Testing

“…[1][2][3][4] Home medication use in children with cancer is highly complex: doses change from day to day, liquids are difficult to measure, pills must be cut and crushed, and children with cancer take a median of 10 medications daily. 2,4 In a recent editorial, Landrigan et al called for more effective support for parents caring for ill children at home. 5 Our objective was to facilitate the family-centered development of a Web-based intervention, called Home Medication Support (HoMeS), to support home medication use and to assess its the feasibility, acceptability, and usefulness among children with cancer.…”

What is the right approach to infection prevention and control for children living at home with invasive devices?

“…(24,25) Yet the rise of homecare for children with complex medical needs has not been accompanied by a parallel rise in the recognition of these risks, nor in the development of strategies to mitigate them. (26)(27)(28)(29) How best families and children can be supported in in preventing and controlling infection in the community remains poorly understood…”

New Questions on the Road to Safer Health Care

“…From the current study of Walsh et al, 3 it is clear that more effective scaffolding of parents who care for ill children is required. Developing better communication strategies with parents will be crucial.…”

“…In an article in this issue, Walsh et al 3 shine new light on an underexplored facet of the patient safety problem, in a small but rigorous, prospective observational study conducted in the homes of children with cancer. Through direct observations of medication administrations and reviews of patients' prescribed medications, the investigators detected 72 medication errors in just 92 home visits.…”

“…The study by Walsh et al 3 reminds us that we are but at the very beginning of a long and winding road to safer health care. The ongoing epidemic of medical errors became visible to the health care community at large and the public just over a decade ago.…”