Background
Medication errors are common in healthcare; they may cause harm to patients and costs to the
society. Particularly cancer medication process is at high risk for errors. Patient safety inci-
dent reporting and learning systems can be used to identify points of risks and improve the
medication processes in healthcare organisations. The aims of the study were to identify the
points of risks, patient harm, contributing factors, correcting actions and proposed preventa-
tive solutions and their follow-up in the cancer medication process from incident reports and
to evaluate the severity of patient harm by comparing the initially reported patient harm to
the assessment of the harm by expert assessors.
Methods
The data consisted of voluntarily reported incidents (n = 4,196) in cancer treatment units
(n = 81) within three healthcare districts between 2019 and 2020. The inter-rater reliability
was measured by using Cohen's kappa (κ) to determine the degree of conformity between the
assessments of the original data classifiers and expert assessors.
Results
In total, 608 incidents (332 errors, 251 near misses and 25 other identified risk factors) were
reported in all phases of the cancer medication process. The original classifiers underesti-
mated the severity of patient harm compared to the assessment of the expert assessors. The
inter-rater reliability between the expert assessors and original classifiers was acceptable (κ
> 0.41) only in four of 11 phases of cancer medication process; the comparison of all patient
harm assessments showed fair agreement (κ = 0.31).
Conclusions
Patient safety incidents were reported in all phases of the medication process. There is a need
to standardise the assessment of the severity of patient harm. Continuous training to all staff
and the engagement of medication safety officers is needed to increase the reliability of report-
ing and optimise learning from the incidents.