Prescription, Transcription and Administration Errors in Out-Patient Day Care Unit of a Regional Cancer Centre in South India

  • Mathaiyan, Jayanthi (Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Jain, Tanvi (Student Body, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Dubashi, Biswajit (Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Batmanabane, Gitanjali (Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research)
  • 발행 : 2016.05.01


Background: Medication errors are common but most often preventable events in any health care setup. Studies on medication errors involving chemotherapeutic drugs are limited. Objective: We studied three aspects of medication errors - prescription, transcription and administration errors in 500 cancer patients who received ambulatory cancer chemotherapy at a resource limited setting government hospital attached cancer centre in South India. The frequency of medication errors, their types and the possible reasons for their occurrence were analysed. Design and Methods: Cross-sectional study using direct observation and chart review in anmbulatory day care unit of a Regional Cancer Centre in South India. Prescription charts of 500 patients during a three month time period were studied and errors analysed. Transcription errors were estimated from the nurses records for these 500 patients who were prescribed anticancer medications or premedication to be administered in the day care centre, direct observations were made during drug administration and administration errors analysed. Medical oncologists prescribing anticancer medications and nurses administering medications also participated. Results: A total of 500 patient observations were made and 41.6% medication errors were detected. Among the total observed errors, 114 (54.8%) were prescription errors, 51(24.5%) were transcribing errors and 43 (20.7%) were administration errors. The majority of the prescription errors were due to missing information (45.5%) and administration errors were mainly due to errors in drug reconstitution (55.8%). There were no life threatening events during the observation period since most of the errors were either intercepted before reaching the patient or were trivial. Conclusions: A high rate of potentially harmful medication errors were intercepted at the ambulatory day care unit of our regional cancer centre. Suggestions have been made to reduce errors in the future by adoption of computerised prescriptions and periodic sensitisation of the responsible health personnel.


연구 과제 주관 기관 : Indian Council of Medical Research


  1. Bates K, Beddy D, Whirisky C et al. (2010) Determining the frequency of prescription errors in an Irish hospital. Ir J Med Sci, 179, 183-6.
  2. Baysari MT, Westbrook J, Braithwaite J, Day RO (2011) The role of computerized decision support in reducing errors in selecting medicines for prescription. Narrative review. Drug Saf, 34, 289-98.
  3. Berdot S, Sabatier B, Gillaizeau F et al. (2012) Evaluation of drug administration errors in a teaching hospital. BMC Health Serv Res, 12.
  4. Biswas M, Roy DN, Islam M et al (2014) Prevalence and nature of handwritten outpatients prescription errors in Bangladesh. Int J Pharm Pharm Sci, 6, 126-30
  5. Bobb A, Gleason K, Husch M et al. (2004) The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med, 164, 785-92.
  6. Charles K, Cannon M, Hall R, Coustase A (2014) Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events? Perspect Health Inf Manag. PMCID: PMC4272436
  7. Clinical oncological society of Australia, (2008). Guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy.
  8. Dhamija M, Kapoor G, Juneja A (2014) Infusional chemotherapy and medication errors in a tertiary care pediatric cancer unit in a resource-limited setting. J Pediatr Hematol Oncol, 36, 412-5.
  9. Ford C, Killebrew J, Fugitt P, Jacobsen J, Prystas EM (2006) Study of Medication errors on a Community Hospital Oncology Ward. UT Journal of Oncology Practice, 2, 149-54
  10. Fyhr A, Akselsson R (2012) Characteristics of medication errors with parenteral cytotoxic drugs. Eur J Cancer Care, 21, 606-13.
  11. Gandhi T K, Bartel SB, Shulman LN et al. (2005) Medication safety in the ambulatory chemotherapy setting. Cancer, 104, 2477-83.
  12. Garffield, Reynolds M, Dermont L, Franklin (2013) Measuring the severity of prescribing errors: a systematic review. Drug Saf, 36, 1151-57.
  13. van Gijssel-Wiersma DG, van den Bemt PM, Walenbergh-van Veen MC (2005) Influence of computerised medication charts on medication errors in a hospital. Drug Saf, 28, 1119-29.
  14. Institute of Medicine (2000). To Err is Human: Building a safer Health Systems.
  15. Joshi MC (2007) Cytotoxic drug: Towards safer chemotherapy practices. Indian J Cancer, 44, 31-37.
  16. Karna K, Sharma S, Inamdar S, Bhandari A (2012) Study and evaluation of medication errors in a tertiary care teaching hospital - a baseline study. Int J Pharmacy and Pharmaceutical Sciences, 4, 587-93
  17. Karthikeyan M, Lalitha D (2013) A prospective observational study of medication errors in general medicine department in a tertiary care hospital. Drug Metabol Personal Ther, 28, 13-21
  18. Keers RN, Williams SD, Vattakatuchery JJ et al (2014) Prevalence, nature and predictors of prescribing errors in mental health hospitals: A prospective multicentre study. BMJ Open, 4, 6084.
  19. Kumari R, Idris MZ, Bhushan V, Khanna A, Agrawal M, Singh SK (2008) Assessment of prescription pattern at the public health facilities of Lucknow district. Indian J Pharmacol, 40, 243-7.
  20. Mathaiyan J, Jain T, Dubashi B, Reddy KS, Batmanabane G (2015) Prescription errors in cancer chemotherapy: Omissions supersede potentially harmful errors. J Pharmacol Pharmacother, 6, 83-7.
  21. Nguyen HT, Nguyen TD, van den Heuvel ER, Haaijer-Ruskamp FM, Taxis K (2015) Medication errors in Vietnamese hospitals: prevalence, potential outcome and associated factors. PLoS One, 10, 138284.
  22. Oberoi S, Trehan A, Marwaha RK (2014) Medication errors on oral chemotherapy in children with acute lymphoblastic leukemia in a developing country. Pediatr Nlood Cancer, 61, 2218-22.
  23. Ranchon F, Salles G, Spath H et al. (2011). Chemotherapeutic errors in hospitalized cancer patients: attributable damage and extra costs. BMC Cancer, 11, 478.
  24. National Coordinating Council for Medication Error Reporting and Preventing. Available at Accessed on 25 May 2016.
  25. Patel V, Vaidya R, Naik D, Borker P (2005). Irrational drug use in India: A prescription survey from Goa. J Postgrad Med, 51, 9-12.
  26. Phalke VD, Phalke DB, Syed MM et al. (2011) Prescription writing practices in a rural tertiary care hospital in Western Maharashtra, India. Australas Med J, 4, 4-8.
  27. Schachter M (2009) The epidemiology of medication errors: how many, how serious? Br J Clin Pharmacol, 67, 621-23.
  28. Tavva NV, Mohanta GP, Parimalakrishnan S (2011) Medication errors: A prospective study conducted and reported through prescription monitoring in tertiary care teaching hospital. Arch Pharm Pract, 2, 33-7.
  29. Williamson S (2009) Reporting medication errors and near misses. In 'Medications Safety: An essential guide', Eds Courtenay M and Griffiths M. Cambridge University Press, 155-71.
  30. Walsh KE, Dodd KS, Seetharaman K et al. (2009). Medication errors among adults and children with cancer in the outpatient setting. J Clin Oncol, 27, 891-6.
  31. Saghafi F, Zargarzadeh AH (2014) Medication error detection in two major teaching hospitals: What are the types of errors? J Res Med Sci, 19, 617-23.