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Medication saftey oncology setting


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medication saftey Oncology setting

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Medication saftey oncology setting

  1. 1. College of Pharmacy Department of clinical pharmacy Medication Safety Oncology setting Dr. Lamya Alnaim,PharmD, PgCert, PgDipl Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
  2. 2. Introduction • The number of cancer patients is gradually increasing worldwide • The numbers of patients that are receiving chemotherapeutic agents are increasing. • Chemotherapy are used alone or in combination to target cancer cells in the body • Medications may be administered in any form: oral, IV, IM, subcutaneous, intrathecal, etc.
  3. 3. Introduction • These drugs are administered in a wide variety of cancer therapies, both for curative and palliative care • They are used in the treatment of small children up to elderly people. • Chemotherapy drugs, given parentally and orally, are classified as ‘high-alert medications’ according to the ISMP
  4. 4. Reasons for Increased Risk • Complex chemotherapeutic regimens • Chemotherapeutic agents combined with supportive therapies • Complex dosing calculations • Nonstandard nomenclature • Most have a narrow therapeutic index. • Administration variability
  5. 5. Magnitude of Problem • The rate of Chemotherapy medication errors reported in the literature range from 0.4% to 31.9%
  6. 6. Magnitude of Problem • ~11% of incidents caused harm • Types of errors were • Due to omissions like name, age and diagnosis • Due to abbreviations of drugs • Ordering wrong doses by physicians • Noncompliance with administration sequences • One or more errors • Errors occurred in • The prescribing phase • The preparation phase • The administration phase
  7. 7. Intrathecal Vinca Alkaloids • 1968 to 2007, 66 cases have been reported • From 2008 to 2016, 120 cases have been reported in the literature or to regulatory agencies • On 2015, 2 cases of accidental intrathecal vincristine administration scheduled as intravenous injections and the patients died 3 and 6 days after the incidents
  8. 8. Overdose • In 2013, A woman treated for lymphoma with the ESHAP regimen, who died of an overdose of cisplatin. The drug was administered at a rate 4 times greater than the recommended maximum dose.
  9. 9. And what do we have here…. • There no published research that address medication safety related to chemotherapy locally • One observational study looking at adherence to antiemetic guidelines • It showed that 95% of antiemetic prescription pre- chemotherapy regimens did not adhere to the guidelines. • mainly in overtreatment
  10. 10. Most Common Problems • Wrong dose and wrong drug is most common • Administering a total dose for a complete course given as one dose • Errors were multifactorial, the most frequent two reasons of errors are high work volume and inadequate number of staff • Lack of education • Interruption during care
  11. 11. Strategies for Drug Safety Right medication management : • right medication • right patient • right dose • right time • right administration • right registration- right form • right sequence • right administration duration
  12. 12. Error-Prevention Measures • physicians, nurses and pharmacists double-checking chemotherapy orders • Use of TALL-man lettering for Look-Alike, Sound-Alike Drug Names • computerized OR pre-printed orders • Continuing education and staff training • Providing instant access to medication information • Improving systems of reporting errors • Standardizing
  13. 13. Error- Prevention Measures • Clinical pharmacists contributing to safe medication use by providing comprehensive management to patients and medical staff • Clinical Service Center," a multidisciplinary team which controls all chemotherapy protocols and orders prior to the medication reaching the patient. The Oncology Pharmacist
  14. 14. Standardization • Standardizing • Medication preparation, labeling and dispensing • Enhanced the prescribing patterns, prescription completeness, and decreased the potential for medication errors • The National Comprehensive Cancer Network (NCCN) Chemotherapy Order Templates (COT) was launched in 2008 • They delineate Chemotherapy agents and associated supportive care agents, monitoring and safety parameters, and instructions for self-administered agents
  15. 15. Standards American Society of Clinical Oncology/Oncology Nursing Society developed Chemotherapy Administration Safety Standards first issued in 2009 and updated in 2013 and 2016 1 a set of 31 voluntary chemotherapy safety standards for patients with cancer. 2 The standards were explicitly created to address patient safety in the administration of parenteral and oral chemotherapeutic agents in outpatient oncology settings. 3
  16. 16. Standards • An update expanding the standards to include the inpatient setting was published in 2012 • In 2013 to include oral chemotherapy • The updated 2016 standards include • pediatric oncology • introduce new standards: • two person verification of chemotherapy preparation processes, administration of vinca alkaloids via minibags in facilities in which intrathecal medications are administered, • labeling of medications dispensed from the health care setting to be taken by the patient at home
  17. 17. ASHP Guidelines on Preventing Medication Errors with Chemotherapy and Biotherapy • Issued in 2015 • proposed to “mandate the use of pre-printed order forms that standardize practice and force functions” as the first strategy to prevent cancer chemotherapy errors
  18. 18. Medication Safety Self Assessment for Oncology • The International Society of Oncology Pharmacy Practitioners approached the Institute for Safe Medication Practices (ISMP) with a proposal to develop a Medication Safety Self Assessment for Oncology
  19. 19. Medication Safety Self Assessment for Oncology • developing an assessment program that could be used by oncology practice sites around the world • to assess their own practices, identify vulnerabilities • use the information for continuous quality improvement • The final version of the tool consisted of 175 self assessment items, organized according to ISMP’s 10 Key Elements of the Medication Use System
  20. 20. Oral Chemotherapy • oral chemotherapy is often administered on a complex schedule of varied days of dosing, and varied dosing even on one day. • When medication is administered outside of a controlled setting (whether by patients, their families, or other caregivers), issues of compliance are magnified • In the worst case scenario, patients are given paper or electronic prescriptions and little instruction or help getting the prescriptions filled. • At best, there is rarely documentation of medication being ingested, either by patient logs or metabolic testing
  21. 21. Oral Chemotherapy • Issues associated with oral medication administration include the requirement for patient and caregiver education regarding safe handling and reliable administration as well as attaining and disposal of medication • The administration of oral antineoplastic is sufficiently complex that some have suggested that specialty clinics, analogous to anticoagulation management programs, to supervise compliance and monitor for toxicity may be beneficial.
  22. 22. Oral Chemotherapy • In a local study, a 17% incidence of serious adverse effects related to oral chemotherapy were reported and an additional 18% near miss situations • There was a wide variability in the process of care involving oral chemotherapy namely in terms of staff training, process of prescription and administration and patient education
  23. 23. Conclusion • Patient safety has been at the forefront of many international, national, state, and local health care agendas during the past decade. • The importance of proactively reducing the risk of tragic medication errors has been minimized too often because the events have occurred infrequently. • “Rare” but harmful events should not be discounted simply because of low frequency Even if cost and labor may be a little higher