#14

Etiology and epidemiology of prescriptive errors in the practice of clinical oncology. A prospective study

Authors
Gil Deza E. Negro A. Muio M. Juarez D. Aguirre S. Negro F. Morgenfeld E. Rivarola E. Gercovich F.G. Instituto Oncolgico Henry Moore. Buenos Aires. Argentina

Objectives
identification classification epidemiology risk assessment and etiology of prescriptive errors in the oncological practice.

Patient population
Between October 2004 and November 2007, 78.700 prescriptions (for 8,485 pt) were entered into a database and were compared to international therapeutic guidelines (Evidence Based Oncology).

Prescriptive error identification

(ASCO 2007- Abstract # 6504)

Each prescription was classified as:

1- Accomplishing the guidelines: Standard treatment. 2: Failing to accomplish the guidelines: Voluntary deviation from the standard
recommendations

Involuntary deviation from the standard recommendations = prescriptive error

Errors Classification
Misdiagnosis Incorrect stage Comorbidities Drug selection Dose Schedule Treatment length

Epidemiology
Characteristics of the population Demographic data Sex Age

Diagnosis
Stage Treatment Date

Tx: Chemotherapy - Target therapy -Hormonotherapy Immunotherapy-Supportive care

Prescriptor Specialty Clinical Oncology - Hematology - Urology

Potential risk of the prescription

High: potentially life threatening
(Toxicity Grade 4)

Moderate: expected decrease on the

quality of life (Toxicity Grade 2-3)

Low: unexpected impact on the quality of

life ( Toxicity Grade 0-1)

Etiology
(According to the physician in charge)
A- Unawareness: errors attributed to a transient
attention deviation (Ex. misdiagnosis)

B- Missing Information in the clinical record

(Ex. treatment duration, cummulative dose,etc)

C- Burn-out syndrome: mistakes related to a stressful job or burocratic loads.

Results

10

Results
Between Oct-2004 and Nov-2007 78,700 Oncological tx. 8,485 pt.

Standard Recommendations 76,616 tx 6,883, pt

Deviations from the Standard Recommendations 2084 tx 1,602 pt

Voluntary deviation 1,667 tx 1,236 pt

Involuntary deviation (Medical Error) 397 tx 366 pt

Sex

54 %

46 %

Age

% Mean: 58.2 years. Std Dev: 15.8

Diagnosis (%)

Stage of disease
Advanced (Stage IV) 33,6% Early (Stage I+II) 37,6%

Loco-Regional (Stage III) 28,8%

Therapies

Type of errors (%)

Monthly Distribution of the Errors(%)

Holidays

Errors
Prescriptors Specialty (%)

Potential Risk (%)

Associated to prescriptive errors

Probable cause of the errors

(According to the physician in charge)

Conclusions
1- One out of 25 patients could be affected by a prescriptive error in the oncological practice. 2- The potential risk caused by the error is moderate to high in 50% of the cases. 3- The most frequent error was related to the dose but misdiagnosis, drug selection, and incorrect staging represent 40% of the cases. 4- Prescriptor awareness, accurate clinical records and burn out syndrome control could reduce the error rate.

A Medical Errors Prevention Program

1. Hystopathological Review 2.Unified Clinical Records 3.Personalized Physician in charge 4.Therapeutical Guidelines 5.Weekly Tumor Board. Follow up

Treatment prescription

Random sampling of clinical records

1. Detailed Prescription Form 2. All prescriptions are contrasted with national and international guidelines.

Treatment indication

Standard Recommendations

Deviations from the Standard Recommendations

Voluntary Double Treatment Control Reevaluation

Medical error Correction

A Medical Errors Prevention Program

1. Hystopathological Review 2.Unified Clinical Records 3.Personalized Physician in charge 4.Therapeutical Guidelines 5.Weekly Tumor Board. Follow up

Treatment prescription

Random sampling of clinical records

1.Detailed Prescription Form 2. All prescriptions are contrasted with national and international guidelines.

Treatment indication

Standard Recommendations

Deviations from the Standard Recommendations

Voluntary Double Treatment Control Reevaluation

Medical error Correction