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Medication Errors on Oral Chemotherapy in Children With ALL in a Developing Country

Sapna Oberoi, Amita Trehan and Ram Kumar Marwaha from the Division of Haematology/Oncology in The Hospital for Sick Children,Toronto, Canadaa nd from the Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India have just published in Pediatric Blood and Cancer an article entitled Medication Errors on Oral Chemotherapy in Children With Acute Lymphoblastic Leukemia in a Developing Country. They report 12% of medications errors related to 4.5 % prescription errors and 7.5% administrations errors during the oral treatment of ALL. On multivariate analysis, education status less than or equal to primary school of the caregiver (OR=3.9, 95% CI 1.3–11.2, P<0.012) and methotrexate (OR=3.9, 95% CI 1.2–13.0, P<0.024) were independently associated with errors. This of course is a major caveat of oral treatment and a special attention and education of both caregivers and caretakers when prescribing metronomic therapy.


Background. Medication errors occur universally. Inappropriate administration of chemotherapy drugs can have adverse effects in cancer patients. Our objective was to assess the rate and type of medication errors in children with acute lymphoblastic leukemia (ALL) receiving oral chemotherapy in outpatient setting. Procedure. Prescription and administration of oral chemotherapy drugs in children with ALL were evaluated prospectively to determine rate and type of medication errors. Errors were defined as prescription (physician) level or administration (patient) level errors. Results. Two hundred eighty-nine drugs were prescribed to 121 patients. Medication errors occurred in 36 (12.5%) prescriptions; 21(7.3%) were administration errors, 13 (4.5%) were prescribing errors, and two errors occurred at both levels. Mercaptopurine (6-MP) was significantly associated with higher rates of errors (Odds ratio [OR]¼2.1, 95% CI [confidence interval] 1–4.1) whereas lapses were less with dexamethasone (OR¼0.25, 95% CI 0.09–0.67). As a result of medication errors 28 (23.1%) patients received inappropriate doses. Twenty five (21%) patients received sub-optimal doses whereas three got higher doses of chemotherapy. On univariate analysis, socioeconomic status, education status of the caregiver, 6-MP and methotrexate were significantly associated with errors (P-0.05). On multivariate analysis, - primary school education of the caregiver and prescription of methotrexate were independent predictors of errors. Conclusions. Medication errors affected nearly one fourth of the children receiving oral chemotherapy. Future studies are needed to look at effective interventions to avoid chemotherapy associated errors especially amongst the lower strata of society.

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