ASHP REPORT Chemotherapy errors
ar
ASHP REPORT
Layar
Preventing chemotherapy errors: Updating guidelines to meet new challenges Barry R. Goldspiel, Robert DeChristoforo, and James M. Hoffman Am J Health-Syst Pharm. 2015; 72:668-9
The full guidelines appear in the online version of this issue (www.ajhp.org).
D
espite the publishing of the ASHP Guidelines on Preventing Medication Errors with Antineoplastic Agents in 2002,1 medication errors with chemotherapy and biotherapy have continued to occur. With evolving technologies and new anticancer therapies, cancer treatment regimens have become more complex, with even greater potential to cause medication errors. The original version of the guidelines was uniquely comprehensive by including all parts of the healthcare system involved with medication use for patients with cancer. This comprehensive approach was retained in the updated guidelines (published as an online-only article in this issue) because every perspective must be considered to promote the safe use of chemotherapy. The current guidelines also build on and complement other standards that have been published since 2002.2 Given the diversity of agents now used to treat cancer, care was
taken to provide a new and more complete definition of chemotherapy and biotherapy intended to encompass any medication used in cancer treatment. (For simplicity, the term chemotherapy is used throughout the guidelines and this summary.) This broad definition includes medications administered by all routes. The guidelines emphasize that all medications falling under this definition, regardless of indication or route of administration, are high-risk medications that require the recommended safety procedures. The guidelines stress the importance of recognizing the unique risks of oral chemotherapy and provide 14 specific recommendations to consider when oral agents are included in a treatment regimen, most notably pharmacist access to the patientspecific information required to validate orders and partnering with patients to ensure that the regimen is followed. The growing use of oral chemotherapy raises many other important issues that are outside the scope of
Barry R. Goldspiel, Pharm.D., BCOP, FASHP, is Deputy Chief; and Robert DeChristoforo, M.S., FASHP, is Chief, Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, MD. James M. Hoffman, Pharm.D., M.S., BCPS, FASHP, is Medication Outcomes and Safety Officer and Associate Member, Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN. Address correspondence to Bruce Hawkins ([email protected]).
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Am J Health-Syst Pharm—Vol 72 Apr 15, 2015
these guidelines, such as safe handling, cost, and access, especially coverage parity between oral and intravenous chemotherapy. Another important addition is the inclusion of recommendations for using technology in the chemotherapy preparation process, especially computerized provider order entry (CPOE) with clinical decision support and barcode technology. The use of CPOE for chemotherapy has lagged behind other order types, most likely because of the complex nature of these orders, including investigational drug regimens. The complexity of chemotherapy orders requires more analysis and resources to safely implement in CPOE, and the guidelines provide recommendations to address these challenges. The application of other technologies, such as barcode technology during chemotherapy preparation with photographic or video documentation of the preparation process, can provide new safety checks and facilitate documentation that is difficult or impossible with manual systems.
Dr. Hoffman’s contributions supported by Cancer Center Core grant NCICA21765 and the American Lebanese Syrian Associated Charities. The authors have declared no potential conflicts of interest. Copyright © 2015, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/15/0402-0668. DOI 10.2146/sp150004
ASHP REPORT Chemotherapy errors
Pharmacists should examine their organization’s entire medication-use system for patients with cancer to ensure that processes for patient safety address the increasing complexity of current cancer therapies. The updated ASHP guidelines provide a framework for such an evaluation. Areas of particular focus include ensuring that (1) the organization’s definition of chemotherapy encompasses all medications used for the treatment of cancer, (2) safety procedures are required regardless of the route of administration or indication for use, (3) systems for safe use of oral chemotherapy are in place, and (4) technologies such as CPOE and barcode scanning improve chemotherapy safety. References 1. American Society of Health-System Pharmacists. ASHP guidelines on preventing medication errors with antineoplastic agents. Am J Health-Syst Pharm. 2002; 59:1648-68. 2. Neuss MN, Polovich M, McNiff K et al. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract. 2013; 9(suppl):5s-13s.
Am J Health-Syst Pharm—Vol 72 Apr 15, 2015
669
ar
ASHP REPORT
Layar
Preventing chemotherapy errors: Updating guidelines to meet new challenges Barry R. Goldspiel, Robert DeChristoforo, and James M. Hoffman Am J Health-Syst Pharm. 2015; 72:668-9
The full guidelines appear in the online version of this issue (www.ajhp.org).
D
espite the publishing of the ASHP Guidelines on Preventing Medication Errors with Antineoplastic Agents in 2002,1 medication errors with chemotherapy and biotherapy have continued to occur. With evolving technologies and new anticancer therapies, cancer treatment regimens have become more complex, with even greater potential to cause medication errors. The original version of the guidelines was uniquely comprehensive by including all parts of the healthcare system involved with medication use for patients with cancer. This comprehensive approach was retained in the updated guidelines (published as an online-only article in this issue) because every perspective must be considered to promote the safe use of chemotherapy. The current guidelines also build on and complement other standards that have been published since 2002.2 Given the diversity of agents now used to treat cancer, care was
taken to provide a new and more complete definition of chemotherapy and biotherapy intended to encompass any medication used in cancer treatment. (For simplicity, the term chemotherapy is used throughout the guidelines and this summary.) This broad definition includes medications administered by all routes. The guidelines emphasize that all medications falling under this definition, regardless of indication or route of administration, are high-risk medications that require the recommended safety procedures. The guidelines stress the importance of recognizing the unique risks of oral chemotherapy and provide 14 specific recommendations to consider when oral agents are included in a treatment regimen, most notably pharmacist access to the patientspecific information required to validate orders and partnering with patients to ensure that the regimen is followed. The growing use of oral chemotherapy raises many other important issues that are outside the scope of
Barry R. Goldspiel, Pharm.D., BCOP, FASHP, is Deputy Chief; and Robert DeChristoforo, M.S., FASHP, is Chief, Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, MD. James M. Hoffman, Pharm.D., M.S., BCPS, FASHP, is Medication Outcomes and Safety Officer and Associate Member, Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN. Address correspondence to Bruce Hawkins ([email protected]).
668
Am J Health-Syst Pharm—Vol 72 Apr 15, 2015
these guidelines, such as safe handling, cost, and access, especially coverage parity between oral and intravenous chemotherapy. Another important addition is the inclusion of recommendations for using technology in the chemotherapy preparation process, especially computerized provider order entry (CPOE) with clinical decision support and barcode technology. The use of CPOE for chemotherapy has lagged behind other order types, most likely because of the complex nature of these orders, including investigational drug regimens. The complexity of chemotherapy orders requires more analysis and resources to safely implement in CPOE, and the guidelines provide recommendations to address these challenges. The application of other technologies, such as barcode technology during chemotherapy preparation with photographic or video documentation of the preparation process, can provide new safety checks and facilitate documentation that is difficult or impossible with manual systems.
Dr. Hoffman’s contributions supported by Cancer Center Core grant NCICA21765 and the American Lebanese Syrian Associated Charities. The authors have declared no potential conflicts of interest. Copyright © 2015, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/15/0402-0668. DOI 10.2146/sp150004
ASHP REPORT Chemotherapy errors
Pharmacists should examine their organization’s entire medication-use system for patients with cancer to ensure that processes for patient safety address the increasing complexity of current cancer therapies. The updated ASHP guidelines provide a framework for such an evaluation. Areas of particular focus include ensuring that (1) the organization’s definition of chemotherapy encompasses all medications used for the treatment of cancer, (2) safety procedures are required regardless of the route of administration or indication for use, (3) systems for safe use of oral chemotherapy are in place, and (4) technologies such as CPOE and barcode scanning improve chemotherapy safety. References 1. American Society of Health-System Pharmacists. ASHP guidelines on preventing medication errors with antineoplastic agents. Am J Health-Syst Pharm. 2002; 59:1648-68. 2. Neuss MN, Polovich M, McNiff K et al. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract. 2013; 9(suppl):5s-13s.
Am J Health-Syst Pharm—Vol 72 Apr 15, 2015
669
