medication errors

[1980rnad]

I am a retired RN, a 30 year breast cancer survivor, and the mother of a 30 something who has recently been diagnosed with breast cancer. I just finished an in depth 2 month study of everything I could find regarding breast cancer, chemo protocols, the drugs, etc. I think I have a decent handle on current trends in cancer science and treatment; however, something has happened that leaves me with questions I can't find answers for. My daughter [i'll call her Sarah] went for her second AC tx today by herself, and a medication error was made at the oncology unit. [background: her children were off school today for teacher conferences; Sarah felt comfortable on her own, so I stayed back to care for the children at my house. After she left, I discovered that one of the kiddies was c/o of a sore throat with mildly elevated temp. of 100.2.]

Back to the oncology unit: The staff reviewed her labs prior to initiating tx, but actually looked at her labs from two weeks ago, rather than the labs done today - ie the day of tx. After infusing all of the Adriamycin dose and 3/4 of the cytoxan, the nurse discovered today's actual labs showing wbc's of 1.0 (1,000) prior to tx. The last 1/4 of cytoxan was dc'd, and the doctor was notified. The plan is for Sarah to receive Neupogen sq qd x 5 days, to complete a course of antibiotic tx with Cipro, and to present to a hospital ED if she develops a temp of 100. No other insructions were given.

I realize her risk based on the current neutopenia, the need for avoidance of crowded places, protection from people who may be ill, nutritional support and all that. I took Sarah's sick child to her doctor where she was dx with a strep throat infection, and was started on an antibiotic; the other children are disease free at this point. The children will stay with me for the next two days to protect Sarah from their infection.

My question is this: what can we expect in terms of recovery from the neutropenia (based on effect from the dose of AC she received today + the effect of the neupogen over the next 5 days)? One med site listed a precaution AGAINST giving neupogen within 24 hours of receiving cytoxan, so I am worried about that also - (Sarah says she received her first dose of neupogen today on the unit). Can anyone offer some experienced insight? Thanks.

[XB9S, BSN, MSN, EdD, RN, APN]

I am really sorry you are going through this now, the questions you ask are things you need to be asking your daughters medical team This isn't something we can do here as under the terms of service we are unable to offer medical advice.