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Intrathecal chemotherapy: potential for medication error.

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Intrathecal (IT) chemotherapy medication errors, particularly with vincristine, lead to severe toxicity and death. Prevention strategies, including safer drug administration methods, are crucial for patient safety in oncology and hematology.

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Area of Science:

  • Oncology
  • Pharmacology
  • Patient Safety

Background:

  • The central nervous system is a sanctuary site for malignant diseases.
  • Intrathecal (IT) chemotherapy is frequently used alongside standard protocols.
  • This administration route presents a significant risk for medication errors.

Purpose of the Study:

  • To systematically review the literature on medication errors during IT chemotherapy administration.
  • To identify common errors, implicated drugs, and associated outcomes.
  • To inform the development of preventative strategies.

Main Methods:

  • A systematic review of English-language literature from January 1960 to June 2013.
  • Inclusion of case reports, clinical studies, and review articles on IT medication errors.
  • Exhaustive reference searching for additional relevant citations.

Main Results:

  • Twenty-two cases of IT methotrexate overdose and one of cytarabine overdose were reported.
  • Numerous cases involved antineoplastic agents intended for parenteral administration being given intrathecally.
  • Vincristine was implicated in 31 cases, resulting in 25 deaths, with other agents also cited. Profound toxicity and death are common outcomes, with many errors going unreported.

Conclusions:

  • Effective prevention strategies must be developed and integrated into international oncology and hematology practices.
  • Recommendations include eliminating syringe administration for vinca alkaloids, using small-volume IV bags, and developing novel intraspinal drug delivery methods.
  • The nursing profession is pivotal in leading the implementation of these preventative strategies.