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Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: A multisite
Chris I Wong1,2, Kathryn Vannatta3,4, Jordan Gilleland Marchak5,6
1Pediatric Hematology-Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
Insights
Outpatient medication errors harmed 10% of children with leukemia or lymphoma. Improving communication among caregivers and with clinicians could prevent most harm, especially for children on many medications.
Area of Science:
- Pediatric Oncology
- Medication Safety
- Health Outcomes Research
Background:
- Limited longitudinal data exists on medication errors and harm in outpatient pediatric cancer patients.
- Focus on children with leukemia and lymphoma receiving outpatient treatment.
Purpose of the Study:
- To characterize the rates and types of medication errors.
- To determine the frequency and nature of harm resulting from these errors in outpatient pediatric cancer patients over a 7-month period.
Main Methods:
- Longitudinal study involving 131 children with leukemia or lymphoma across three pediatric cancer centers.
- Medication errors identified through chart review, in-home reviews, administration observation, and interviews.
- Physician reviewers confirmed errors and harm using validated methods (Fleiss' κ).
Main Results:
- 408 medication errors identified, with 242 having potential for harm and 39 resulting in harm (1.0 harm per 1000 patient-days).
- 10% of children experienced harm due to medication errors; 42% had errors with potential for harm.
- Children on >13 medications had significantly more serious errors (77% vs 61%). Miscommunication contributed to 26% of caregiver-reported errors.
Conclusions:
- 10% of pediatric leukemia/lymphoma patients experienced adverse drug events from outpatient medication errors.
- Improved communication strategies, co-developed with families and using human-factors engineering, are crucial for preventing harm.
Background:
There is little longitudinal information about the type and frequency of harm resulting from medication errors among outpatient children with cancer. We aimed to characterize rates and types of medication errors and harm to outpatient children with leukemia and lymphoma over 7 months of treatment.
Methods:
We recruited children taking medications at home for leukemia or lymphoma from three pediatric cancer centers. Errors were identified by chart review, in-home medication review, observation of administration, and interviews. Physician reviewers confirmed error (Fleiss' κ = 0.95), harm (Fleiss' κ = 0.82), and suggested interventions. Generalized linear mixed models with random effects were used to account for clustering by site.
Results:
Among 131 children taking 1669 medications with 367 home visits, 408 errors were identified, including 242 with potential for harm and 39 with harm (1.0 harm per 1000 patient-days [95% CI, 0.1-9.8]). Ten percent of children were injured by errors and 42% had errors with potential for harm. Twenty-six percent of caregivers reported that miscommunication led to missed doses or overdoses at home. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%).
Conclusions:
In this longitudinal study, 10% children with leukemia or lymphoma experienced adverse drug events because of outpatient medication errors. Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering.
Plain Language Summary:
In this longitudinal study, medication errors in the clinic, pharmacy, or at home among children with leukemia or lymphoma over a 7-month period were common, and 10% suffered harm because of errors. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%). Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering.
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