Chemotherapy Errors

As of this writing, I have received chemotherapy by infusion (IV) for more than five of the past eight years. That’s five or six different series of chemotherapy treatments, with the following drugs, either alone or in combination: Adriamycin (generic: doxorubicin), Taxol (paclitaxel), Herceptin (trastuzumab), Zometa (zoledronic acid), Zolodex (goserelin), Navelbine (vinorelbine), and Avastin (bevacizumab). I've also had a couple of oral chemo drugs, including Cytoxan (cyclophosphamide).

At present, I am receiving treatment with two targeted therapies, Herceptin and Avastin, which have fewer side effects than conventional chemotherapy drugs like Taxol. And I take oral Cytoxan every day.

So I’ve had a lot of experience with chemotherapy, and it no longer frightens me. But that doesn’t mean I sit back and space out while my nurses are hooking me up to the IV pump, either.

This is what I do: Whenever I start a new series of chemotherapy treatments, I get the details from my medical oncologist and I write them down. I have a page in my date book where I list:

• The name of the drug (both generic and brand name)
• The dose
• How often I am to receive the drug
• How many treatments in total I am supposed to have
• How long each infusion is supposed to run
• The name and dose of any premedications (or “premeds,” the drugs I take before chemo to help with side effects), and
• Any other drugs I may be getting, for example drugs to boost my red or white blood cell counts.

My doctor or his nurse also gives me a printout on any new drug that lists all sorts of information, including side effects to watch for. I read these—even though they are pretty scary—and I save them for future reference.

I receive my treatment at a cancer center in Seattle as an outpatient. Whenever I check in for treatment, I get an armband that is printed with my full name, date of birth, and patient ID number. Once I’m settled in the chair or bed and the chemotherapy drugs have arrived from the pharmacy, two nurses check each drug against my chart and against my armband.

This is a safety check, and I pay attention while it’s going on. If something doesn’t sound right to me, I pull out my notebook to see what I have written down. And if I have any doubts or questions at all, I ask my nurse. If there is a question the two of us are unsure about, we page my oncologist’s nurse and check it with her.

Many drug names are very similar, and doctors and nurses are not consistent in the names they use. Sometimes they use the generic name and at other times, or for other drugs, they will use the brand name or a shortened form of the name.

The first time I received chemotherapy, my medical oncologist told me I would be getting a drug called doxorubicin, but the nurses in the infusion suite were calling it “adria,” short for the brand name, Adriamycin. This confused me, and several times I said, “Don’t you mean doxorubicin?”—until I finally got it straight.

I have one nurse who is assigned to me as my “primary nurse” for chemotherapy treatments. This is a great system, and if the hospital where you are getting chemotherapy doesn’t do things this way, you should ask them to.

My nurse and I have a relationship. We know each other. She knows about my kids and what is going on in my life. She knows the ins and outs of my treatment. And she knows my veins (no small thing when you are getting poked often).

When I go in for treatment and my primary nurse is taking care of me, I have a sense of safety and security that I don’t have with someone else, even though I know and like many of the other nurses.

Mistakes are more likely to happen when you have a substitute. Just recently, if I had not spoken up I would not have gotten one of the four drugs I was supposed to receive, because the orders were not in my chart. If I hadn’t been paying attention and had not said something, the nurse would not have known and I would not have gotten the drug.

Would this have harmed me? No, probably not. But it was a mistake, one that I caught by knowing which drugs I am supposed to receive and on what schedule.

And just a few weeks ago, my chemo nurse, who, again, was not my regular nurse, forgot to do the safety check with a second nurse. She was hooking up the drug when I said, "Did I miss it? Did you do the double check?" She quickly apologized and called in another nurse.

In addition to the formal safety check of the drugs, I pay attention to procedures. If I don’t have my regular nurse, the substitute might do things differently, which may be fine—but I always ask if something’s not the same as usual.

Another check you can do is to pay attention to the color of the drug (most are clear, but doxorubicin is red, for example), and look at how full the bag is at the beginning—does it look the same as usual? If not, say something.

@ Jeanne Sather 2006

Comments

[Lynn]

After each of my four
doses of Adriamycin (+ a second drug) IV, I was to expect and experience bright red or orange urine
(immediately following).
However, one of these infusions, which had additional extreme side effects, I DID NOT experience the brightly colored urine immediately after the 2 hour infusion. Would this in itself indicate a wrong dose or medication?

[Jeanne]

Hi Lynn--I don't think you have anything to worry about, but I am not the right person to answer your question, as I am just a cancer patient like yourself.

Did you call your doctor or nurse to ask about this?

Let me know what they say.

Jeanne