Mistakes of healthcare workers during antineoplastic infusions: how can we prevent them?
Authors: Zotov O.S. 
Published: July 2021

Background. 39 years old Betsy Lehman, which in 1994 took part in a clinical study, died because of the excessive infusion of cyclophosphamide (4 times higher dose). The mistake was revealed only in 10 weeks after the patient’s death. Now there is a Betsy Lehman Center of Patient Safety and Decrease of Medical Errors. According to the definition, medication error is an unintended failure in the drug treatment process that leads to, or has the potential to lead to the harm of the patient. In turn, wrong usage of the drug is an intentional misuse not in accordance with the instruction for medical usage (including, with some illegal aims). According to the statistics, only in USA medical errors harm 44,000-98,000 patients annually and cause the death of 7,000 patients.

Objective. To define the main concepts of medical errors and methods of their avoidance.

Materials and methods. Analysis of literature data on this topic.

Results and discussion. Categories of medical mistakes include the mistakes of prescribing, of dispensing, of preparation, of administration and of monitoring. Retrospective analysis of the correctness of drug administration had revealed that the risk factors of mistakes included patient’s age <15 y. o. or >64 y. o., and a big quantity of administered drugs. Nurses with different professional experience equally often made mistakes; mistakes were more often during night shifts. Medical mistakes in oncology have some peculiarities. Namely, in oncology the drug dose often depends on the body surface and other factors; exceeded dose is accompanied by the high toxicity, and the insufficient dose – by the severe decrease of treatment effectiveness; anticancer treatment is accompanied by the administration of the big amount of additional drugs (antiemetics, hemopoesis stimulators, glucocorticoids, etc.). Analysis of chemotherapy of 1311 adult patients, which underwent the treatment in the university clinics of Valencia (Spain), revealed the mistakes in 17.2 % of cases. Mistakes in drug prescription were the most often (75.7 %). Similar French study revealed the mistakes in 5.2 % of cases, the majority of them (91 %) were also the mistakes in prescription (wrong choice of treatment regimen, incomplete prescriptions, inadequate doses). Such mistakes have not only medical, but also the social and economic consequences, including the increase of treatment cost. Meta-analysis of R. Ashokkumar et al. (2018) revealed that the frequency of medical errors in oncology, according to the different studies, was about 0.004-41.6 %. There is one more problem: because of the fear of punishment healthcare workers hide their errors, that’s why the small amount of errors may not be the real favorable parameter, but just a result of incomplete notification. Factors of medical mistakes appearance are divided into 3 groups: due to healthcare workers (training level, knowledge, physical and emotional condition), due to clinics administration (presence of treatment standards, communication quality, registration and analysis of error cases) and social (staff workload, time limitations, workplace organization, payment). With the aim of prevention of medical errors in oncology we must implement the treatment standards and local protocols, control technics of preparation and administration of anticancer drugs, widen the network of clinical pharmacists, use external drug compounding, thoroughly manage the medical documents, introduce electronic control systems and improve the communication between medical workers. Talking about legal aspects, concept of medical error does not have any legal consolidation. Literature includes about 70 its definitions. In case of a complaint of patient or his/her relatives healthcare workers will be asked such questions: whether the diagnostics of the patient was complete, whether the diagnosis was correct and timely made, what are the causes of the unfavorable outcomes, is there any direct causative link between healthcare workers’ actions and these outcomes, whether there was any standards’ violations. In general, vague criteria of standardization of medical care decrease the level of legal protection of both patients and healthcare workers.

Conclusions. 1. Medical errors are quite often, but their exact incidence can’t be established. 2. Medical errors in oncology have some peculiarities because of the peculiarities of tumor treatment. 3. With the aim of prevention of medical errors in oncology we must implement the treatment standards and local protocols, control technics of preparation and administration of anticancer drugs, widen the network of clinical pharmacists, use external drug compounding, thoroughly manage the medical documents, introduce electronic control systems and improve the communication.