Multisite Parent-Centered Risk Assessment to Reduce Pediatric Oral Chemotherapy Errors

Walsh, Kathleen E.; Mazor, Kathleen M.; Roblin, Douglas W.; Biggins, Colleen; Wagner, Joann L.; Houlahan, Kathleen E.; Li, Justin W.; Keuker, Christopher P.; Wasilewski‐Masker, Karen; Donovan, Jennifer L.; Kanaan, Abir O.; Weingart, Saul N.

doi:10.1200/jop.2012.000601

Cited by 29 publications

(35 citation statements)

References 24 publications

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“…38,39 Some communication-based errors may be prevented by using strategies developed in hospitals around handoffs. In adult patients with chronic disease, pharmacist case-management involving health information technology has been used to support home medication use.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…); and a technology firm (InterVision Media, Eugene, OR). Twenty-three parents of children with cancer contributed to development of this intervention: 18 identified sources of error and proposed components of the intervention during focus groups, 4 one on our development team (D.B.) and four as advisors.…”

Section: Methodsmentioning

confidence: 99%

“…1,2,4,6 We first developed paper mockups of the Web site components and content pages. Mock-ups and draft interfaces were reviewed and iteratively revised by the stakeholder team.…”

Section: Development Processmentioning

confidence: 99%

“…[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.…”

Section: Introductionmentioning

confidence: 99%

“…2,6 We also worked with parents who identified common failures that led to errors in home chemotherapy use. 4 These parents systematically identified Web-based intervention components that would help prevent these errors.…”

Section: Introductionmentioning

confidence: 99%

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

Walsh

Biggins

Blasko

et al. 2014

JOP

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Purpose: Errors in the use of medications at home by children with cancer are common, and interventions to support correct use are needed. We sought to (1) engage stakeholders in the design and development of an intervention to prevent errors in home medication use, and (2) evaluate the acceptability and usefulness of the intervention. Methods:We convened a multidisciplinary team of parents, clinicians, technology experts, and researchers to develop an intervention using a two-step user-centered design process. First, parents and oncologists provided input on the design. Second, a parent panel and two oncology nurses refined draft materials. In a feasibility study, we used questionnaires to assess usefulness and acceptability. Medication error rates were assessed via monthly telephone interviews with parents. Results:We successfully partnered with parents, clinicians, and IT experts to develop Home Medication Support (HoMeS), a family-centered Web-based intervention. HoMeS includes a medication calendar with decision support, a communication tool, adverse effect information, a metric conversion chart, and other information. The 15 families in the feasibility study gave HoMeS high ratings for acceptability and usefulness. Half recorded information on the calendar to indicate to other caregivers that doses were given; 34% brought it to the clinic to communicate with their clinician about home medication use. There was no change in the rate of medication errors in this feasibility study. Conclusion:We created and tested a stakeholder-designed, Web-based intervention to support home chemotherapy use, which parents rated highly. This tool may prevent serious medication errors in a larger study.

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

Wong

Vannatta

Marchak

et al. 2023

Cancer

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Multisite Parent-Centered Risk Assessment to Reduce Pediatric Oral Chemotherapy Errors

Abstract: Parents of pediatric oncology patients readily participated in a proactive risk assessment method, identifying processes that pose a risk for medication errors involving home oral chemotherapy.

Cited by 29 publications

References 24 publications

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

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

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

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

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