We appreciate the comments by Drs Dickens, Sinsabaugh, and Winger as an opportunity to continue the discussion on improving safety in pediatric chemotherapy.
First, to clarify the type of error classified as medication order/treatment plan mismatches: our divisional policy requires that each chemotherapy order identify precisely the therapy that is due (including protocol, treatment arm, course, cycle, week, and day). If any of this information was missing or did not match the treatment plan verbatim, pharmacists and nurses were expected to reject the order as potentially incorrect or unclear, and prescribers were expected to generate a corrected order to ensure accurate delivery of the intended therapy. In our study, it was these mismatches in the specification of the point in therapy that increased. The wrong agent, dose, route, or schedule was never prescribed.