Table 1.

Highest Risk Failure Modes and Recommended Strategies to Reduce Risks

Modes and Strategies

Highest risk failure modes

Miscommunication when the clinician instructs family to change the dose

Family misunderstands

Multiple conflicting instructions from different staff

Miscommunication when telling other caregivers at home about a change in medication dose

Confusion about timing with respect to food, bed time, other pills leads to a mistake

Person handling chemotherapy at home has not been told to wear gloves and does not do so

Child refuses to take or vomits medication for several days

Incorrrect dose measured because wrong equipment used

One home caregiver administers the medication when unaware that someone else has already given the medication

On admission, the hospital does not carry oral chemotherapy and the family did not bring theirs from home

Recommended strategies to reduce risks Streamline current processes Receive updated home medication list One designated point of contact at clinic Bring all home caregivers who give medicine at home to doctor visits Additional information/support from clinicians Print or e-mail after visit summaries Virtual help/support via e-mail or Web portal Visiting nurse, once or multiple visits Information about when to call the doctor about home medication use Standard form for parents to take notes during doctor visits Medication calendar with check boxes Additional information/support from parents Parent-run listserve/chat room or “parent-run WebMD”