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Article

Development of a Policy and Procedure for Accidental Chemotherapy Overdose

Wendelin K. Nelson
Joan Moore
Judith A. Grasso
Lisa Barbarotta
David S. Fischer
CJON 2014, 18(4), A1-A7 DOI: 10.1188/14.CJON.18-04AP

A policy regarding rapid response to chemotherapy overdoses was developed by the authors in an attempt to minimize morbidity and mortality. The parameters of a chemotherapy overdose were defined to promote early recognition of an overdose incident. Resources needed to guide potential therapeutic interventions and required monitoring were developed. The policy defines the immediate actions to be taken in the event of a chemotherapy overdose. The availability of a chemotherapy overdose policy provides an enhanced level of safety for patients by ensuring that appropriate treatment is initiated without delay. The development of the policy was in response to the reporting of a tragic error at another institution. Healthcare providers must recognize and address potential areas of vulnerability to maximize patient safety.

References 

Bradley, A.M., Buie, L.W., Kuykendal, A., & Voorhees, P.M. (2012). Successful use of intrathecal carboxypeptidase G2 for intrathecal methotrexate overdose: A case study and review of the literature. <i>Clinical Lymphoma, Myeloma, and Leukemia, 13</i>, 166-170. doi:10.1016/j.clml.2012.09.004

Doroshow, J.H., McCoy, S., MacDonald, J.S., Issell, B.F., Patel, T., Cobb, P.W., & Abbruzzese, J.L. (2006). Phase II trial of PN401, 5-FU and leucovorin in unresectable or metastatic adenocarcinoma of the stomach: A Southwest Oncology Group study. <i>Investigational New Drugs, 24</i>, 537-542.

Erdlenbruch, B., Pekrun, A., Schiffmann, H., Witt, O., & Lakomek, M. (2002). Accidental cisplatin overdose in a child: Reversal of acute renal failure with sodium thiosulfate. <i>Medical and Pediatric Oncology, 38</i>, 349-352.

Fischer, D.S., Alfano, S., Knobf, M.T., Donovan, C., & Beaulieu, N. (1996). Improving the cancer chemotherapy use process. <i>Journal of Clinical Oncology, 14</i>, 3148-3155.

Goldfrank, L.R. (Ed.). (2006). <i>Goldfrank's manual of toxicologic emergencies</i> (8th ed.). Philadelphia, PA: McGraw-Hill.

Goodin, S., Griffith, N., Chen, B., Chuk, K., Daouphars, M., Doreau, C., … Meier, K. (2011). Safe handling of oral chemotherapeutic agents in clinical practice: Recommendations from an international pharmacy panel. <i>Journal of Oncology Practice, 7</i>, 7-12.

Grush, O.S., & Morgan, S.K. (1979). Folinic acid rescue for vincristine toxicity. <i>Clinical Toxicology, 14</i>, 71-78.

Hamadani, M., & Awan, F. (2006). Role of thiamine in managing ifosfamide-induced encephalopathy. <i>Journal of Oncology Pharmacy Practice, 12</i>, 237-239.

Hidalgo, M., Villalona-Calero, M., Eckhardt, S., Rodriguez, G., Hammond, L.A., Diab, S.G., … Rowinsky, E.K. (2000). Phase I and pharmacologic study of PN401 and fluorouracil in patients with advanced solid malignancies. <i>Journal of Clinical Oncology, 18</i>, 167.

Institute for Safe Medical Practices. (2007). Fluorouracil incident RCA: Follow-up. <i>ISMP Canada Safety Bulletin, 7</i>(4), 1-4.

Institute of Medicine. (2000). <i>To err is human: Building a safer health system</i>. Washington, DC: National Academies Press.

Jackson, D.V., Wu, W.C., & Spurr, C.L. (1982). Treatment of vincristine-Induced ileus with sincalide, a cholecytokinin analog. <i>Cancer Chemotherapy and Pharmacology, 8</i>, 83-85.

Katzenbach, J.R., & Smith, D.K. (1994). <i>Wisdom of teams.</i> New York, NY: Harper Collins.

Leu, L., & Baribeault, D. (2010). A comparison of the rates of cisplatin (cDDP)-induced nephrotoxicity associated with sodium loading or sodium loading with forced diuresis as a preventative measure. <i>Journal of Oncology Pharmacy Practice, 16</i>, 167-171.

Moore, J., Grasso, J., Barbarotta, L., Nelson, W., & Fischer, D.S. (2009). When prevention fails, policy for accidental chemotherapy overdose [Abstract 3678]. Retrieved from <a target="_blank" href='http://www.nursinglibrary.org/vhl/handle/10755/164777'>http://www.nursin...

Morgan, K.P., Buie, L.W., & Savage, S.W. (2012). The role of mannitol as a nephroprotectant in patients receiving cisplatin therapy. <i>Annals of Pharmacotherapy, 46</i>, 276-281.

O'Marcaigh, A.S., Johnson, C.M., Smithson, W.A., Patterson, M.C., Widemann, B.C., Adamson, P.C., & McManus, M.J. (1996). Successful treatment of intrathecal methotrexate overdose by using ventriculolumbar perfusion and intrathecal instillation of carboxypeptidase G<sub>2</sub>. <i>Mayo Clinic Proceedings, 71</i>, 161-165.

Osborne, J., Blais, K., & Hayes, J.S. (1999). Nurses' perceptions: When is it a medication error? <i>Journal of Nursing Administration, 29</i>(4), 33-38.

Patel, P.N. (2006). Methylene blue for the management of Ifosfamide-induced encephalopathy. <i>Annals of Pharmacotherapy, 40</i>(2), 299-303.

Rahiem Ahmed, Y.A.A., & Hasan, Y. (2013). Prevention and management of high dose methotrexate toxicity. <i>Journal of Cancer Science Therapeutics, 5</i>(3), 106-112.

Saif, W.M., Ezzedlin, H., Vance, K., Sellers, S., & Diasio, R.B. (2007). DPYD*2A mutation: The most common mutation associated with PDP deficiency. <i>Cancer, Chemotherapy and Pharmacology, 60</i>, 503-507.

Solimando, D.A. (Ed.). (2012). <i>Drug information handbook for oncology</i> (10th ed.). Hudson, OH: Lexi-Comp.

Thomas, L.L., Brat, P.C., Somers, R., & Goudsmit, R. (1982). Massive vincristine overdose: Failure of leucovorin to reduce toxicity. <i>Cancer Treatment Reports, 66</i>, 1967-1969.

Vik, T., Slordahi, S., & Moe, P.J. (1985). An overdose of vincristine in an eleven-year-old boy. <i>Pediatric Hematology-Oncology, 2</i>, 167-170.

Wang, R.Y. (2006). Antineoplastic overview. In N.E. Flomenbaum, L.R. Goldfrank, R.S. Hoffman, M.A. Howland, N.A. Lewis, and L.S. Nelson (Eds.), <i>Goldfrank's manual of toxicologic emergencies</i> (8th ed., pp. 770-778). Philadelphia, PA: McGraw-Hill.

Widemann, B.C., Balis, F.M., Kim, A., Boron, M., Jayaprakash, N., Shalabi, A., … Adamson, P.C. (2010). Glucarpidase, leucovorin, and thymidine for high-dose methotrexate-induced renal dysfunction: Clinical and pharmacologic factors affecting outcome. <i>Journal of Clinical Oncology, 28</i>, 3979-3986.