Improving Patient Safety in Clinical Oncology: Applying Lessons From Normal Accident Theory

JAMA Network

 The Institute of Medicine (IOM) has highlighted patient safety as an urgent health care quality problem,^1,2 estimating that 44 000 to 98 000 Americans die annually from preventable medical errors,^1,3 and more recent estimates are even higher.....
  
SAFETY CONCERNS WITHIN CLINICAL ONCOLOGY

The medication error rate in the outpatient chemotherapy setting has been reported to be approximately 3% to 19%,^6,7 depending on the specific practice setting. In a survey of adult outpatients receiving chemotherapy, 42 (22%) of 193 believed that they had experienced unsafe care.⁸ A survey of 1013 health care professionals from 9 oncology departments in Switzerland⁹ reported that 54% observed their colleagues making potentially harmful errors. Seventy percent reported sometimes remaining silent about safety concerns, and 37% reported remaining silent when they could have helped prevent an incident. The same research group¹⁰ surveyed patients and found that 16% reported experiencing an error in their care, and 11% were very concerned about the errors.¹⁰

Radiotherapy-associated errors were noted to occur in about 1% to 4% of patient treatments in single-institution reports, with most errors being not clinically serious.¹¹ Registry data note a much lower error rate (about 1 to 4 in 10 000) because only a small fraction of errors cross the threshold triggering reporting.¹¹ In a survey of radiation therapists, 16% reported being personally reprimanded for raising concerns about safety.¹²

These data are concerning both for the prevalence of safety issues and the apparent “suppression” of reporting them. National professional societies have recognized these issues, published white papers to describe best practices, and hold annual safety meetings.....