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A study conducted by researchers at Dana-Farber Cancer Institute (DFCI) and Brigham and Women’s Hospital (BWH), and published in the online journal Cancer, evaluated chemotherapy errors that occur during outpatient care.

The researchers report that while the mistakes they found were not life-threatening, error prevention could still be more effective.
Both DFCI and BWHl, which are in the forefront of efforts to provide excellent standards of care and increased patient safety, consented to share drug-order and patient-safety records with investigators.

The research teams at the two institutions evaluated, over 10,000 medication orders from Dana-Farber’s adult and pediatric ambulatory oncology infusion clinics.

Researchers determined that 3% of the orders contained errors, one-third of which were considered serious. 82% of the errors in adults and 60% in children were found to be possibly hazardous.

Pharmacists and nurses, however, caught 45% of these dangerous errors before they reached patients, and none turned out to be detrimental.  

The most common error in both the adult-clinic, which is computerized, and the pediatric clinic, which uses a paper system, was omitted or incorrect dosages and failure to discontinue orders.

The results show that, while safeguards such as computerized order-entry systems — used at both Dana-Farber and Brigham and Women’s — significantly reduce drug-order errors, additional improvements are still possible, and essential.


To address the problem with order errors, DFCI is implementing a series of new policies including the transfer of the pediatric clinic to computer orders.

In the adult clinics, the computer system has been upgraded to incorporate more detailed information. For example, physicians must now order drugs that need to be administered together simultaneously.

In response to the possible threat of an avian flu pandemic, the Food and Drug Administration (FDA) has announced the formation of a Rapid Response Team to ensure that an adequate supply of anti-influenza drugs, such as Tamiflu, are available for Americans.

In partnership with the Department of Health and Human Services, Centers for Disease Control and Prevention, National Institutes of Health and Industry, the Rapid Response Team will work to ensure that every necessary measure is taken to provide an adequate and timely supply of avian flu treatments.

They will address roadblocks to increased manufacturing of products that have already been proven effective against avian flu, they will support clinical studies to test new potential treatments for avian influenza, and they will facilitate the development and availability of safe and effective pandemic vaccines.

The FDA is also taking steps to counter the sale of counterfeit or fraudulent avian flu treatments.  They are working with individuals in the U.S. drug distribution system to strengthen the safety and security of the domestic drug supply by:

·    Actively monitoring internet sites and partnering with internet service providers to identify and stop fraudulent activity.
·    Aggressively seeking out and prosecuting those who seek to prey on innocent people in a time of crisis.
·    Encouraging pharmaceutical manufacturers to take advantage of new technologies that provide protective packaging and other features to ensure that products are both authentic and tamperproof.

The FDA Counterfeit Alert Network is ready to help disseminate information in the event of a counterfeit incident.  To minimize the risk of counterfeit or fraudulent flu treatments, the FDA recommends the following:

·    Consumers should buy medicines only from U.S. state-licensed pharmacies.
·    When buying medicines over the Internet, consumers should look for the National Association of Boards of Pharmacy VIPPS seal.  This seal tells consumers that the web site has been certified and it is a legitimate pharmacy.
·    Only use medicine that had been prescribed for you by your doctor and do not rely on websites that will provide you with a prescription for medicines without a true doctor-patient relationship.

As new data emerges that health care spending has little relationship to health outcomes, a new study finds a correlation between the behavior of doctors and the total heath care dollars spent.

According to researchers at the VA Outcomes Group in White River Junction, Vermont and Dartmouth Medical School, physicians practicing in regions of the United States where health care spending is high are more likely to order tests, referrals, and treatments for their patients than those in low-spending regions.

Health care spending varies widely across the county and the study sought to determine whether spending discrepancies were due to patients being different (higher illness rates in certain parts of the country) or doctors being different.

The researchers surveyed 5490 primary care physicians, presenting them with clinical scenarios and asking how often they would order a specific test, referral, or treatment for each patient described.  They found that doctors who practiced in areas of high-spending consistently ordered more tests, referrals, and treatments than doctors who practiced in low-spending areas.

For example, when presented with a 35-year old man with prolonged back pain and foot weakness after heavy lifting, physicians in high-spending regions would order an MRI scan 82% of the time.  This compared to 69% of the time for physicians in low-spending regions.

The study’s primary author, Dr. Brenda Sirovich, Staff Physician at the White River Junction VA Medical Center and assistant professor of medicine at Dartmouth Medical School said “The strength of this study is that we were able to isolate the role of physicians in explaining the huge differences that we see in practice and spending across the regions.” 

The authors acknowledge that it is unlikely that physician behavior alone explains higher levels of spending in some regions of the country, and that differences in patient expectations may influence spending as well.  They do suggest that health care in the United States could cost up to 30% less if all regions could safely adopt the more conservative practice patterns of lower-cost regions.

The study appears in the October 24, 2005 issue of Archives of Internal Medicine.