Analysis of the approach to risk management in onco-hematology centers: results of a survey in Italy.

Purpose: Raccomandazione 14 (Recommendation 14), issued by the Italian Ministry of Health, is aimed at providing requirements for preventing medication errors with antineoplastic drugs. Raccomandazione 14 covers all steps of the process, from supply to administration of therapies with specific conclusive guidance on tools and methods to be adopted for the assessment and management of clinical risk.

Methods: A form and a score system were designed and provided to healthcare professionals for self-assessment of adherence to Raccomandazione 14. Data were collected during 2014-2015 and a score was given to each item. Specific gaps were listed for each center.

Results: A total of 27 healthcare institutions participated in the project, with 447 healthcare personnel (physician, nurses, and pharmacists) involved. The mean overall adherence score for all items covered by Raccomandazione 14 was 2.8 (out of 4). Items with scores <2.8 were considered priority targets for intervention for risk mitigation (general requirements, supply, oral administration, therapy management for injected antineoplastic drugs in home care setting administration, and involvement of patients in care process). The other items of Raccomandazione 14 defined as core processes in the management of anticancer therapies achieved an overall mean score of 3.1 (storage/inventory management, prescription, preparation, distribution, and administration). Following the analysis of the results, the 27 participating institutions activated a range of 3-29 actions/institution for improving adherence to best practice requirements.

Conclusions: The survey was able to identify specific gaps with Raccomandazione 14 at different institutions throughout Italy so that the healthcare professionals involved were able to prioritize improvement actions that should be able to minimize risk in the management of oncologic drugs in the in-hospital setting.