Abstract
6136 Background: The aim of this study is to quantify medication errors (ME) in a multidisciplinary system with a Computerized Pharmacotherapy Process (CPP) in cancer patients. Methods: Longitudinal, prospective, and cohorts study during 2 years (January, 2003-December, 2004) in adult patients who received antineoplastic treatment in Oncology and Haematology services. ME were identified by double cross-validation of every stage of the pharmacotherapy process (prescription, preparation, dispensation, administration and follow-up) carried out by the multidisciplinary team (physician, pharmacist, nurse) with CPP assistance. Variables: number of ME for 1000 patients-day, % according to the stage of the process and severity (scale to 1 -not damage in the patient- to 5 -irreversible damage-) of ME intercepted. Results: 638 patients were on treatment and ME were identified in 225 (35%). On a total of 18,785 preparations and 13,206 patients-day, 276 ME were detected, equivalent to 20.9 ME by 1000 patients-day (95%CI: 18.5–23.5); of these 16.8 ME for 1000 patients-day (80.1%) were intercepted and did not reach a patient (95%CI: 14.6–19.1). ME detected distribution according to the stage were: prescription 75.7% (95%CI: 70.2–80.7), preparation 21.0% (95%CI: 16.4–26.3), dispensation 1.8% (95%CI: 0.6–4.2), administration 1.1% (95%CI: 0.2–3.1), and follow-up 0.4% (95%CI: 0.01–2.0). ME distribution according to the severity were: grade 1: 15.9% (95%CI: 11.8–20.8), grade 2: 49.6% (95%CI: 43.6–55.7), grade 3: 33.7% (95%CI: 28.1–39.6), grade 4: 0.7% (95%CI: 0.1–1.6) and none of grade 5. The system intercepted 98.9% (95%CI: 94.3–99.9) of ME with severity equal or greater than 3 -ME with potential to damage the patient- and 70.2% (95%CI: 62.9–76.7) of severity equal or minor to 2, ME without clinical significance. Conclusions: The multidisciplinary system with well-established CPP detects 20.9 ME for 1,000 patients-day and intercepts 98.8% of ME with potential to damage the oncology patient. No significant financial relationships to disclose.
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