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Oncology Nurses' Perceptions About Involving Patients in the Prevention of Chemotherapy Administration Errors

David L. B. Schwappach

Marc-Anton Hochreutener

Martin Wernli

chemotherapy, prevention
ONF 2010, 37(2), E84-E91. DOI: 10.1188/10.ONF.E84-E91

Purpose/Objectives: To explore oncology nurses' perceptions and experiences with patient involvement in chemotherapy error prevention.

Design: Qualitative descriptive study.

Setting: In- and outpatient oncology units of a community hospital in Switzerland.

Sample: 11 actively practicing oncology nurses working in an ambulatory infusion unit or on wards.

Methods: Oncology nurses participated in two focus groups on two occasions. Participants discussed their personal experiences with patients intervening to intercept errors, attitudes toward patient involvement in error prevention, and changes in relationships with patients. A content-analysis framework was applied to the transcripts and analytical categories were generated.

Main Research Variables: Perceptions about patient involvement in error prevention.

Findings: Participants shared affirmative attitudes and overwhelmingly reported positive experiences with engaging patients in safety behaviors, although engaging patients was described as a challenge. Nurses intuitively chose among a set of strategies and patterns of language to engage patients and switch between participative and authoritative models of education. Patient involvement in error prevention was perceived to be compatible with trustful relationships. Efforts to get patients involved have the potential for frustration if preventable errors reach patients. Considerable differences exist among organizational barriers encountered by nurses.

Conclusions: Nurses acknowledged the diverse needs of patients and deliberately used different strategies to involve patients in safety. Patient participation in safety is perceived as a complex learning process that requires cultural change.

Implications for Nursing: Oncology nurses perceive patient education in safety as a core element of their professional role and are receptive to advancing their expertise in this area.

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    Basch, E., Artz, D., Dulko, D., Scher, K., Sabbatini, P., Hensley, M., … Schrag, D. (2005). Patient online self-reporting of toxicity symptoms during chemotherapy. Journal of Clinical Oncology, 23, 3552-3561. doi: 10.1200/JCO.2005.04.275
    Basch, E., Artz, D., Iasonos, A., Speakman, J., Shannon, K., Lin, K., … Schrag, D. (2007). Evaluation of an online platform for cancer patient self-reporting of chemotherapy toxicities. Journal of the American Medical Informatics Association, 14, 264-268. doi: 10.1197/jamia.M2177
    Bradley, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Services Research, 42, 1758-1772. doi: 10.1111/j.1475-6773.2006.00684.x
    Coulter, A. (2006). Patient safety: What role can patients play? Health Expectations, 9, 205-206. doi:10.1111/j.1369-7625.2006.00405.x
    Davis, R. E., Koutantji, M., & Vincent, C. A. (2008). How willing are patients to question healthcare staff on issues related to the quality and safety of their healthcare? An exploratory study. Quality and Safety in Health Care, 17, 90-96. doi: 10.1136/qshc.2007.023754
    Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62, 107-115. doi: 10.1111/j.1365-2648.2007.04569.x
    Entwistle, V. A. & Quick, O. (2006). Trust in the context of patient safety problems. Journal of Health Organization and Management, 20, 397-416. doi: 10.1108/14777260610701786
    Finkelstein, J. B. (2006). E-prescribing first step to improved safety. Journal of the National Cancer Institute, 98, 1763-1765.
    Fränneby, U., Sandblom, G., Nyren, O., Nordin, P., & Gunnarsson, U. (2008). Self-reported adverse events after groin hernia repair: A study based on a national register. Value in Health, 11, 927-932. doi: 10.1111/j.1524-4733.2008.00330.x
    Gandhi, T. K., Bartel, S. B., Shulman, L. N., Verrier, D., Burdick, E., Cleary, A., … Bates, D. W. (2005). Medication safety in the ambulatory chemotherapy setting. Cancer, 104, 2477-2483. doi: 10.1002/cncr.21442
    Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: Concepts, procedures, and measures to achieve trustworthiness. Nursing Education Today, 24, 105-112. doi: 10.1016/j.nedt.2003.10.001
    Hibbard, J. H., Peters, E., Slovic, P., & Tusler, M. (2005). Can patients be part of the solution? Views on their role in preventing medical errors. Medical Care Research and Review, 62, 601-616. doi: 10.1177/1077558705279313
    Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277-1288. doi: 10.1177/1049732305276687
    Institute of Medicine. (2000). To err is human. Building a safer health system. Washington, DC: National Academy Press.
    Joint Commission. (2008). Speak up initiatives. Retrieved from
    Kloth, D. D. (2002). Prevention of chemotherapy medication errors. Journal of Pharmacy Practice, 15, 17-31. doi: 10.1106/EXK5-5F5M-T5QV-45CW
    Lustig, A. (2000). Medication error prevention by pharmacists—An Israeli solution. Pharmacy World and Science, 22, 21-25. doi: 10.1023/A:1008774206261
    Luszczynska, A., & Gunson, K. S. (2007). Predictors of asking medical personnel about handwashing: The moderating role of patients' age and MRSA infection status. Patient Education and Counseling, 68, 79-85. doi: 10.1016/j.pec.2007.05.008
    Mayring, P. (2000). Qualitative content analysis. Retrieved from
    Muller, T. (2003). Typical medication errors in oncology: Analysis and prevention strategies. Onkologie, 26, 539-544. doi: 10.1159/000074148
    Murphy, E., & Dingwall, R. (2003). Qualitative methods and health policy research. New York, NY: Walter de Gruyter.
    Peters, E., Slovic, P., Hibbard, J. H., & Tusler, M. (2006). Why worry? Worry, risk perceptions, and willingness to act to reduce medical errors. Health Psychology, 25, 144-152. doi: 10.1037/0278-6133.25.2.144
    Rinke, M. L., Shore, A. D., Morlock, L., Hicks, R. W., & Miller, M. R. (2007). Characteristics of pediatric chemotherapy medication errors in a national error reporting database. Cancer, 110, 186-195. doi: 10.1002/cncr.22742
    Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing and Health, 23, 334-340.
    Schulmeister, L. (1999). Chemotherapy medication errors: Descriptions, severity, and contributing factors. Oncology Nursing Forum, 26, 1033-1042.
    Schwappach, D. L. (2008). "Against the silence": Development and first results of a patient survey to assess experiences of safety-related events in hospital. BioMed Central Health Services Research, 8, 59. doi: 10.1186/1472-6963-8-59
    Schwappach, D. L. (2009). Engaging patients as vigilant partners in safety: A systematic review. Retrieved from
    Taylor, J. A., Winter, L., Geyer, L. J., & Hawkins, D. S. (2006). Oral outpatient chemotherapy medication errors in children with acute lymphoblastic leukemia. Cancer, 107, 1400-1406. doi: 10.1002/cncr.22131
    Unruh, K. T., & Pratt, W. (2006). Patients as actors: The patient's role in detecting, preventing, and recovering from medical errors. International Journal of Medical Informatics, 76(1, Suppl.), S234-S244. doi: 10.1016/j.ijmedinf.2006.05.021
    Vaughn, S., Shay Schumm, J., & Sinagub, J. (1996). Focus group interviews in education and psychology. Thousand Oaks, CA: Sage.
    Vincent, C. A., & Coulter, A. (2002). Patient safety: What about the patient? Quality and Safety in Health Care, 11, 76-80. doi: 10.1136/qhc.11.1.76
    Walsh, K. E., Dodd, K. S., Seetharaman, K., Roblin, D. W., Herrinton, L. J., Von Worley, A…. Gurwitz, J. H. (2009). Medication errors among adults and children with cancer in the outpatient setting. Journal of Clinical Oncology, 27, 891-896. doi: 10.1200/JCO.2008.18.6072
    Weingart, S. N., Pagovich, O., Sands, D. Z., Li, J. M., Aronson, M. D., Davis, R. B., … Phillips, R. S. (2005). What can hospitalized patients tell us about adverse events? Learning from patient-reported incidents. Journal of General Internal Medicine, 20, 830-836. doi: 10.1111/j.1525-1497.2005.0180.x
    Weingart, S. N., Price, J., Duncombe, D., Connor, M., Sommer, K., Conley, K. A., … Ponte, R. R. (2007). Patient-reported safety and quality of care in outpatient oncology. Joint Commission Journal on Quality and Patient Safety, 33, 83-94.
    Weissman, J. S., Schneider, E. C., Weingart, S. N., Epstein, A. M., David-Kasdan, J., Feibelmann, S., … Gatsonis, C. (2008). Comparing patient-reported hospital adverse events with medical record review: Do patients know something that hospitals do not? Annals of Internal Medicine, 149, 100-108.