New chemotherapy guidelines aim to fix errors of the past


By Tessa Hoffman

16 Nov 2017

An overhaul of chemotherapy guidelines aims to prevent a repeat of the dosing scandals that dogged two health systems in the recent past.

The updated guidelines for safe prescribing, dispensing and administration of cancer chemotherapy are “much more robust” than the first 2008 version, says Dr Christine Carrington, who led the joint project between COSA and Cancer Council Australia.

The document aims to “guide best practice practice to minimise things like what happened in Adelaide happening again” said Dr Carrington, referring to the case in which a typographical error in a chemotherapy dosing protocol led to 10 patients receiving incorrect doses at Royal Adelaide Hospital and Flinders Medical Centre between 2014 and 2015.

This case, along with a second dosing scandal in NSW, has formed part of the evidence base drawn on to inform the guidelines’ second edition, said Dr Carrington, assistant director of cancer pharmacy at Princess Alexandra Hospital in Brisbane.

“We have put a lot more in about roles and responsibilities are of individuals and double-checking systems, people checking each other, what are high risk populations.”

Mitigating against prescribing errors is a focus.

“A lot of errors happen in prescribing, not deliberately just because it’s a three step process and a process that’s very prone to error,” she said.

“We now know the evidence on what can minimise these errors.”

There is a new section on complementary therapies, with clinicians advised to investigate what patients are using to address the risk of drug interactions.

While there is typically good acceptance of clinical guidelines, when it comes to practice guidelines it can be a different story with some clinicians resenting being told what to do.

“Telling medical staff how they should be prescribing is always controversial,” she said.

“One of the challenges…is finding out how people follow them, if they use them and what difference they make.”

The guidelines can be accessed here. 

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