Oral anticancer medicines are commonly administered in primary and secondary care, with 24 million doses being administered during 2006-2007 (NPSA 2008). The NPSA has received high numbers of patient safety incidents concerning oral anti-cancer medicines.

Common causes of patient harm included:
• Wrong doses being prescribed
• Wrong frequency being prescribed
• Wrong course duration being prescribed

The standards for prescribing oral anti-cancer medicines should be the same as those for injectable chemotherapy (NPSA 2008). This means that they should only be initiated by a cancer specialist and prescribed only in the context of a written protocol or treatment plan. The patient should also be given full verbal and written confirmation about their oral-cancer medication upon initiation. This must include details on the intended regime, the treatment plan and any monitoring arrangements that are in place. As a non-cancer specialist, you may occasionally be asked to prescribe on-going anti-cancer medication for a patient. You must always discuss this with a cancer specialist first to ensure it is appropriate. You must then make sure you have access to all written protocols and treatment plans, including guidance on monitoring and the management of toxicity, before you prescribe anything. Your local cancer network can provide you with a range of chemotherapy education resources, such as competency packs, teaching packs and work books. They will also provide you with the local treatment protocols for adults and children and relevant patient information. If you do not know how to access your local cancer network, log on to www.ncat.nhs.uk and you will be directed.

Never events

Never Events - NHS England provides a list of 'never events' and records data on reported 'never events' - How many never events do you think occur annually in England each year?

There were 306 'never events' (see below) recorded by NHS England for the year 2014-15 - would seem somewhat surprising when these events should 'never' happen.

Type of Never Event (Number)
Wrong site surgery (124)
Retained foreign object post procedure (102)
Wrong implant/ prosthesis (40)
Inappropriate administration of daily oral methotrexate (11)
Misplaced naso or oro gastric tubes (10)
Misidentification of patients (4)
Wrong gas administered (2)
Maladministration of a potassium containing solution (2)
Escape of a transferred prisoner (2)
Maladministration of insulin (2)
Air embolismn (2)
Transfusion of ABO - incompatible blood components (2)
Wrong route administration of oral / enteral treatment (1)
Wrongly prepared high risk injectable medication (1)
Wrong route administration of chemotherapy (1)
Total 306


In this section we have discussed factors to consider when prescribing red flag medicines. We have considered some of the evidence showing why this is and commonly reported errors associated with their use. For each of these medicines, we have considered some of the national guidance on how they should be prescribed. We have also considered how to access this guidance, together with other learning resources available to you. Familiarising yourself with these will help you to develop the necessary knowledge and skills to prescribe safely.

Copyright eBook 2019, University of Leeds, Leeds Institute of Medical Education.