National multi-center study on chemotherapy safety practice

Abstract

17569 Background: Safety practice is an important quality indicator of cancer care. Given the potential toxicity of chemotherapy (CT), the safety practices of intravenous (IV) CT for cancer have received little attention. The purpose of this study was to characterize the safety practices of prescribing IV CT and examine their association with the adverse drug events (ADR) after CT in Taiwan. Methods: A total sample of 948 medical records of newly diagnosed breast (BC), lung (LC), colon-rectal (CRC) and oral cancer (OC) were drawn via proportional probability random sampling from 7 medical centers across the Taiwan. Using data from reviewing the medical records, the safety practices were measured as characteristics of prescribing IV CT, including record of protocol name, format of prescriptions, calculation of dosage and double checking. Near-miss prescription (NM) was determined as percentage of inconsistent, unrecognized recordings about the CT regiments throughout the CT course, or unreadable prescription. ADR was determined as percentage of re-utilizations of healthcare that were associated with the CT complications after administering the CT. Inter-rater agreement of 90% or above was achieved. Results: The sample were consisted of 31% BC (n=293), 28% LC (n=265), 27.3% CRC (n=259) and 13.8% OC (n=131), with mean age of 56 years old and stage III or IV at the half. No calculation of dosage was accounted for 52%. There was 8.3% (n=79) of near-miss IV CT prescription. The ADR included 10% (n=95) re-hospitalization and 32% of clinic visits associated with the CT complication. The NM was significant related with the cancer type of LC (OR=1.96), no record of protocol name and not pre-print CT prescription. The ARD related to the CT was significantly more likely to be those whose CT prescriptions were without double checking and not pre-print CT prescription. ADR was not related to the occurrence of NM. Conclusions: These results indicated that there is a gap remained in the prescribing safety practice. Misses of some safety practices was related to rate of the re-hospitalization or clinic visits that were related to the CT complication. No significant financial relationships to disclose.