NEW YORK (Reuters Health) - Medication errors among patients with cancer are increasing as treatment shifts from the hospital to the outpatient setting, according to research published in the Journal of Clinical Oncology.

"Outpatient chemotherapy regimens are particularly complex because of the intense monitoring required, unanticipated and frequent changes in medication doses based ... and medications taken only on certain days of the week or month," lead investigator Dr. Kathleen E. Walsh, at the University of Massachusetts Medical Center in Worcester, and co-authors explain.

To determine how often and why errors occur, Walsh's team reviewed medical records at four outpatient cancer clinics for visits between September 2005 and May 2006. The data covered 1379 clinic visits and 11,908 prescribed medications.

Among adult patients, they identified 90 medication errors, for a rate of 7.1 errors per 100 visits. Fifty-five errors were potentially injurious, including 11 errors that did result in injury.

There were 117 treatment visits by children involving 913 medications. Of 22 medication errors, 9 could have caused injury and 4 actual injuries occurred.

One problem was confusion over two sets of orders -- one written at diagnosis and another adjusted dose on the day of administration -- with medication administered from the wrong set of orders. "Requiring that medication orders not be written until the day of administration, following review of laboratory results," may reduce errors, the authors suggest.

Other strategies to reduce errors among adult patients were improved communication and bar coding.

For children, Walsh and associates recommend "drug dose double-checking, improved communication, and patient education about home medication use."

Although these rates are higher than previously reported, the investigators note that the estimates are likely to be conservative since they rely solely on medical record review.

SOURCE: Journal of Clinical Oncology, online December 29, 2008.

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