In response to the death of a 43-year-old Canadian woman after a fluorouracil overdose, the Institute for Safe Medication Practices has issued these guidelines to help safeguard chemotherapy:

• Standardize chemotherapy labels to include all information needed at the infusion pump, including hourly infusion rate, concentration, and total volume, preferably in the order needed. Eliminate confusing or unneeded information from the label.
• Review and improve the process by which nurses are certified to deliver chemotherapy.
• Evaluate all infusion pumps used to deliver chemotherapy to identify possible sources of confusion or programming error. Use smart pumps when possible.
• Standardize the process for double-checking dosages, and reduce the need for manual use of calculators. Use dosing charts when possible.
• Use checklists to help standardize chemotherapy preparation and administration.
• Review data-input screens with patients as part of patient-teaching about the chemotherapy regimen.
• Develop standardized protocols for responding aggressively to chemotherapy overdose, and require all staff who administer chemotherapy to be skilled in identifying and managing toxicity.

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