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Safeguarding the administration of high-dose chemotherapy: a national practice survey by the American Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 1997 Dec;3(6):331-40 PMID: 9502301

Pubmed ID

9502301

Abstract

Overdoses of high-dose chemotherapy before hematopoietic cell transplantation are serious adverse events, but their frequency and etiology are unknown. The American Society for Blood and Marrow Transplantation (ASBMT) conducted an anonymous national survey to identify errors in safety practices during the administration of high-dose chemotherapy. The questionnaire was returned from 115 (68%) of 170 hematopoietic transplant centers in the United States. Ninety-four of the programs were university or affiliated centers, 19 were community hospitals, and 41 were founded since 1990. A total of 7650 transplants were reported for 1994: 22% of the programs performed 1-20 transplants, 60% performed 21-100 transplants, and 18% performed more than 100 transplants. Fifteen of the 115 responding centers reported a total of 18 patients inadvertently given overdoses of cisplatin (n=3), carboplatin (n=2), busulfan (n=2), cytosine arabinoside (n=2), cyclophosphamide (n=2), interleukin-2 (n=2), or other agents (n=5) between 1989 and 1994. Cumulative drug doses given as a daily dose (six cases) and nursing infusion errors (six cases) were the most common errors. The estimated chemotherapy overdose error rate was 0.06%, or 6 cases/10,000 transplants, with 95% confidence limits of 0.03-0.11%. The overdose rate among more experienced centers in operation before 1990 was lower than that among newer centers (p < 0.01). Large centers (> 100 transplants performed in 1994) experienced errors at rates lower than those in medium-sized centers (21-100 transplants, p = 0.03). Although the number of events was small in this self-reporting survey, overdoses were noted in 13% of the responding centers, especially among more recently established units. Safety practices need to emphasize multidisciplinary checkpoints at the physician, pharmacist, nursing, and institutional levels. Based on these survey results, ASBMT recommendations for further safeguards for high-dose chemotherapy administration are proposed.

Author List

Chen CS, Seidel K, Armitage JO, Fay JW, Appelbaum FR, Horowitz MM, Shpall EJ, Weiden PL, Antman KS, Champlin RE, Kersey JH, Sullivan KM

Author

Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-0031310563   15 Citations

MESH terms used to index this publication - Major topics in bold

Adult
Antineoplastic Combined Chemotherapy Protocols
Blood Banks
Blood Transfusion
Bone Marrow Transplantation
Child
Drug Administration Schedule
Health Care Surveys
Hematopoietic Stem Cell Transplantation
Humans
Neoplasms
Practice Patterns, Physicians'
Societies, Scientific
Surveys and Questionnaires
Tissue Banks
jenkins-FCD Prod-321 98992d628744e349846c2f62ac68f241d7e1ea70