Chemotherapy medication errors are a well-established cause of patient harm. Specifically, recent adverse events related to chemotherapy preparation have occurred where patients died or suffered harm as a result of mixing error. Further, direct observations of pharmacy mixing practice in our recent investigation of ambulatory IV chemotherapy safety in Canada suggest that there is significant potential for admixing errors in Canadian oncology pharmacies as a result of the way materials and processes are organized.6 These errors are not detectable with current pharmacy quality control measures, and would therefore also go undetected in research studies that use methods such as retrospective chart reviews and self-reports. These error detection methods are employed in most medication safety studies, leading us to believe that mixing errors may be under-reported in the literature.
Testing methods such as high-performance liquid chromatography (HPLC) allow the analysis of drug type and concentration of mixed fluids. We therefore propose a pilot study involving HPLC analysis of the contents of prepared parenteral chemotherapy bags collected from of oncology pharmacies pilot sites across Canada to compare the medication order with the mixed drug and its concentration. Through analysis of work processes at each site, we also aim to understand how different approaches to organizing materials and work processes may impact mixing accuracy.
We have assembled a pan-Canadian team of oncology pharmacists, oncology nurses, medical oncologists, human factors experts, statisticians, medication safety experts, and oncology agency leaders who believe that this study, which builds on our past exploratory research, is an important next step in chemotherapy safety research.
Sunnybrook Health Sciences Centre
Justin Michael (student)