How can risk assessment and quality assurance activities minimise errors in cancer therapy?

From Cancer Guidelines Wiki


Quality assurance and risk assessment are an essential part of the safe delivery of cancer therapy.[1][2][3][4]

Routine quality assurance and safety review activities should be proactive rather than reactive and occur in the context of the clinical team, in an environment of trust and a ‘blame free’ culture.

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Evidence Summary

Risk assessment can identify potential risks and preventative measures to minimise errors.[5]

Oncology specific quality use of medicine indicators are described by the "2012 ISMP International Medication Safety Self-Assessment® for Oncology".[6] These are designed for use in overseas based facilities and not all indicators are applicable to the Australian setting. More general indicators for quality use of medicines in hospitals can be found in the Australian Commission on Safety and Quality in Health Care National Quality Use of Medicines Indicators for Australian Hospitals.[7] These indicators are a set of process indicators developed for Australian hospitals and health professionals and are designed to measure the safety and quality of medicines use and drive healthcare practice and quality improvement.

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Consensus-based recommendationQuestion mark transparent.png

A governance body or appointed subcommittee consisting of all disciplines involved in the treatment process for cancer should be established. The governance body or committee should put into place systems for managing risk and processes for quality assurance including the conduct of regular audits.

A system should be in place for reporting adverse events, incidents and near misses (Womer et al, 2002). The “Root, Cause, Analysis” process should be undertaken for sentinel events. Where a near miss could have resulted in a serious adverse outcome it is recommended that a facility undertake a “Failure Mode Effectiveness Analysis” (Leape et al, 1995). A multidisciplinary review of process measures (such as rate and type of incidents and near misses) and outcome measures (such as chemotherapy related adverse events and unplanned admission or readmission rates) should be undertaken regularly to identify “error prone” areas that require remediation or treatment protocols whose use should be re-evaluated.

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The committee responsible for medication safety and quality assurance of cancer therapy should have representation on a hospital wide safety committee. This provides a useful forum for peer discussion, education and resolutions on safety issues that affect the patient population of the facility.

In the case of electronic prescribing systems, processes should be in place to regularly ensure the appropriate functioning of the system and decision support functions.

(Womer et al, 2002)[3] ;(Leape et al, 1995)[5]

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  1. Goldspiel BR, DeChristoforo R, Daniels CE. A continuous-improvement approach for reducing the number of chemotherapy-related medication errors. Am J Health Syst Pharm 2000 Dec 15;57 Suppl 4:S4-9 Abstract available at
  2. Goldspiel B, Hoffman JM, Griffith NL, Goodin S, DeChristoforo R, Montello CM, et al. ASHP guidelines on preventing medication errors with chemotherapy and biotherapy. Am J Health Syst Pharm 2015 Apr 15;72(8):e6-e35 Abstract available at
  3. 3.0 3.1 Womer RB, Tracy E, Soo-Hoo W, Bickert B, DiTaranto S, Barnsteiner JH. Multidisciplinary systems approach to chemotherapy safety: rebuilding processes and holding the gains. J Clin Oncol 2002 Dec 15;20(24):4705-12 Abstract available at
  4. Carrington C, Stone L, Koczwara B, Searle C, Siderov J, Stevenson B, et al. The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy. Asia Pac J Clin Oncol 2010 Sep;6(3):220-37 Abstract available at
  5. 5.0 5.1 Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995 Jul 5;274(1):35-43 Abstract available at
  6. Institute for Safe Medication Practices (ISMP) and the Institute for Safe Medication Practices Canada (ISMP Canada). 2012 ISMP International Medication Safety Self Assessment® for Oncology. [homepage on the internet]; 2012 [cited 2016 Sep]. Available from:
  7. Australian Commission on Safety and Quality in Health Care. National Quality Use of Medicines Indicators for Australian Hospitals.; 2014 [cited 2016 Sep] Available from:

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