Keys to Patient Safety
for Oncology

Susan L. Marr, MSA, CPHRM, Patient Safety/Risk Management Account Executive.

As the first medical professional liability insurer to establish a patient safety department,
The Doctors Company remains the leader in developing innovative tools that can help you reduce risk and keep your patients safe.

Medication safety is critical in oncology.

Because chemotherapeutic agents have narrow therapeutic ranges and are toxic even at the right doses, extreme attention to detail in calculations and administration is required. Errors with these agents can have dire consequences. You should:

  • Ensure and document that staff members who administer chemotherapy are appropriately and thoroughly trained.
  • Develop standardized preprinted medication order forms (paper or electronic) in order to eliminate dosing errors, the omission of critical set elements, and errors in sequencing and intervals.
  • Never permit verbal orders to initiate or modify oncolytic therapy.
  • Use a standard, routine method to calculate drug doses.
  • Organize the medical record in a way that makes it easy for staff to confirm that all prerequisites have been met.

Careful tracking of lab tests and imaging results is imperative.

While important in all settings, careful tracking of lab tests and imaging results is extremely important for cancer patients for whom lost results may mean lost time. Maintain a system in your office that alerts you if a result or report is not received so that prompt follow-up can occur. Also, be sure that the results received are for the test ordered.

Do not file reports, tests, or correspondence of a clinical nature without the provider’s initials or a signature verifying that he or she has reviewed the document.

Once again, the handling of test results is a critical task and is often cited in allegations against physicians who practice office-based care. Also, don’t forget to follow a defined process for reviewing results that come in while the provider is away from the office so that there is no delay in addressing results of an urgent nature.

Partner with the pathologist.

Provide the pathologist with adequate clinical information when a biopsy is requested. In cases where the histology is sharply at odds with the clinical impression, call this to the pathologist’s attention and ask to have the slides reviewed.

Avoid allegations of delay in diagnosis and/or treatment.

Do not defer important tests because a patient is concerned about costs. If the patient refuses a test after being advised of its need and importance, document the patient’s refusal in the medical record. Use definitive diagnostic techniques, and know the limitations of the tests ordered. Timely referrals for challenges in diagnosis and treatment are cost effective and medically appropriate.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J8039H 07/11


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