The COSA guidelines for the safe prescribing, dispensing and administration of systemic cancer therapy (1) are a multidisciplinary collaboration and provide an update of the original guidelines published in 2010 (2). Their aim is to assist in the prevention of medication errors and to improve patient safety with respect to the treatment of cancer.
The guidelines provide recommendations for clinical practice and define best practice by using up-to-date evidence, where available, alongside the expert, consensus opinion of cancer care professionals. Medicine is intrinsically evidence based from robust clinical trials and peer reviewed data. This is not always applicable in patient safety where one or a small number of unintended incidents or errors can support a local or wider change in practice, particularly where it is identified that the same incident could happen in other institutions (e.g. the inadvertent administration of vincristine via the intrathecal route). Some areas of vulnerability may only be identified when an incident occurs that causes, or may cause harm, is brought to the attention of providers and patients in a more public domain. Developing guidelines based on these types of incidents can often cause controversy and a 'it couldn't happen here' approach. The updated guidelines follow the Cancer Council Australia's guideline development methodology and format for web-based clinical practice guidelines on the wiki platform. This enables currency to be maintained as new evidence or information on incidents becomes available and enables wide stakeholder consultation.
As with all guidelines, they have their limitations and cannot be used in isolation. Whilst the purpose of the guidelines is to guide clinical practice, they do not replace the clinician judgment of the many clinicians involved in the process of providing cancer therapy. It is intended that these guidelines be used as a tool to inform local practice and be adapted according to service provision, applicability and availability of resources.
This presentation will discuss the development of the guidelines and some of the controversies that arose during development and consultation.