Key risk factors in intravenous chemotherapy administration safety: a multi-stakeholder qualitative study

Intravenous chemotherapy administration safety has traditionally been examined from stage-specific and professional perspectives, while how risks accumulate across interconnected stages remains insufficiently characterised. Using the World Health Organization medication-use process and Hazard Analysis and Critical Control Points (HACCP) principles as its analytical framework, this qualitative descriptive study aimed to identify key risk factors across the entire intravenous chemotherapy process from the perspectives of nurses, physicians, pharmacists, and patients, and to explain how these risks form, are transmitted, and accumulate. Semi-structured interviews were conducted between April and September 2025 at a tertiary hospital in Suzhou, China, with a purposive, multi-stakeholder sample of 13 oncology nurses, 7 physicians, 3 pharmacists, and 11 patients; data were analysed using directed content analysis in NVivo (version 15.0). Reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). Four themes and 13 subthemes were identified across prescribing, compounding, administration, and monitoring stages, revealing stage-specific vulnerabilities involving information integrity, process verification, implementation consistency, and continuity of care. Risk did not concentrate at any single stage but accumulated and was transmitted in a chain-like pattern at inter-stage junctions. Three cross-cutting risk-transmission mechanisms underpinned this pattern: information discontinuity (incomplete patient information passing unverified between stages and institutions), accountability gaps (risks lacking a clear owner at handovers and after discharge), and procedural-implementation deviation (safety checks retained in form but weakened in function under real-world constraints). These findings suggest that safety management should extend beyond compliance within individual stages to the quality of inter-stage connections: verifying patient information at each transition, clarifying responsibility across professions and care settings, and evaluating whether safety checks still fulfil their verification function. By integrating multiple stakeholder perspectives, this study uncovered cross-stage safety vulnerabilities beyond the scope of single-role assessment. The proposed conceptual risk-transmission framework may inform the design of inter-stage safeguards but warrants testing in multicentre and quantitative studies.