BMJ  2007;334:407 (24 February), doi:10.1136/bmj.39069.489757.55 (published 12 January 2007)

Research

Oral chemotherapy safety practices at US cancer centres: questionnaire survey

Saul N Weingart, vice president for patient safety1, Jonathan Flug, medical student2, Daniela Brouillard, administrative assistant1, Laurinda Morway, research coordinator1, Ann Partridge, staff physician3, Sylvia Bartel, pharmacy director3, Lawrence N Shulman, chief medical officer3, Maureen Connor, vice president for quality improvement and risk management3

1 Center for Patient Safety, Dana-Farber Cancer Institute, Boston, MA 02115, USA, 2 Tufts University School of Medicine, Boston, 3 Dana-Farber Cancer Institute, Boston

Correspondence to: S N Weingart saul_weingart{at}dfci.harvard.edu

Objective To characterise current safety practices for the use of oral chemotherapy.

Design Written questionnaire survey of pharmacy directors of cancer centres.

Setting Comprehensive cancer centres in the United States.

Results Respondents from 42 (78%) of 54 eligible centres completed the survey, after consulting with 89 colleagues. Clinicians at 29 centres used handwritten prescriptions, two used preprinted paper prescriptions, and six used electronic systems for most oral chemotherapy prescribing. For six commonly used oral chemotherapies, on average 10 centres required a diagnosis on the prescription, 11 required the protocol number, four required the cycle number, nine required double checking by a second clinician, 14 required a calculation of body surface area, and 14 required a calculation of dose per square metre of body surface area. Only a third of centres requested patients' written informed consent when oral chemotherapy was given off protocol. Nearly a quarter (10) of centres had no formal process for monitoring patients' adherence. In the past year respondents at 10 centres reported at least one serious adverse drug event related to oral chemotherapy, and respondents at 13 centres reported a serious near miss.

Conclusion Few of the safeguards routinely used for infusion chemotherapy have been adopted for oral chemotherapy at US cancer centres. There is currently no consensus at these centres about safe medication practices for oral chemotherapy.


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