Cancer chemotherapeutic error in hospitalized patients: Attributable damages and extra costs.

Abstract

e19529 Background: Medication errors in hospitalized patients are still relatively common with potential dramatic consequences, specialy with antineoplastic drugs because of their high toxicity, their small therapeutic index and health's status of cancer patients. The aim of this study was to assess antineoplastic medication errors (those which have affected patient and those captured before they occur) in terms of frequency, patients harm and cost. Methods: A 1-year prospective study was conducted in a French 1200-bed university hospital detecting medication errors at every step of the anticancer chemotherapy use process. Severity of medication errors and potential consequences of avoided errors were estimated independently by two physicians. A costs analysis was performed by simulation of potential hospital stays and valued at the complete hospital cost of the corresponding diagnosis related groups. Results: Of 6,607 antineoplastic prescriptions charts, 341 presented at least one error (5.16%) corresponding to 449 medication errors of which 436 were captured before administration to patient. Prescription errors represented 91% of errors followed by pharmaceutical errors (8%) and administration errors (1%). In total, 13.4% of avoided errors would have caused a temporary injury, 2.6% a permanent damage and 2.6% would have compromised the vital prognosis of the patient (including 4 to 8 potential deaths). If not avoided, 216 additional hospital days would have been necessary. Thirteen medication errors reached the patient without damages except 2 patients, needing reinforced monitoring. Avoided medication errors would have caused an estimated annual opportunity cost of 92,907€ with 74% attributed to hospital stays and 26% to drugs. Conclusions: This study demonstrates that major medication errors take place in hospital but that a dedicated control quality system allowed capturing most of them before they reach the patient. Potential consequences for patients and cost of medication errors justify the development of preventive actions. No significant financial relationships to disclose.