Palliative care patients in pain; new research says

The Australian review paper, published in the ‘British Medical Journal (BMJ) Supportive and Palliative Care’ by researchers from New South Wales (NSW) and the University of South Australia, shows that errors involving pain relief medication are almost three times higher than previously reported in other healthcare settings.

As part of the study, researchers looked at opioid errors in three inpatient palliative care services in metropolitan NSW over a two-year period, from 2013-2015.

In the process, researchers noted that more than half of the errors – 57 percent – involved patients receiving a lower dose of pain relief than ordered, with clinical intervention being required in a third of cases – mostly involving patients with cancer aged in their 70s.

Professor from the University of South Australia’s School of Pharmacy and Medical Sciences, Debra Rowett, says the study highlights the importance of understanding why opioid errors occur, particularly lower dosing, which may contribute to patient pain.

“Palliative care clinicians have identified that safe use of opioids is a patient safety priority and this study is an important first step in quantifying and identifying opioid errors,” she says.

“The high rate of errors in palliative care environments compared to other healthcare services most likely reflects the higher volume of opioids such as morphine being used for patients to manage their pain in the last stages of their lives.”

Of the 55 opioid errors identified, most involved morphine dosages (35 percent) and two-thirds related to administration errors.

Researchers say better understanding the factors that contribute to or mitigate opioid errors is a “priority” in this clinical setting.

The researchers add that medication errors pose “one of the greatest risks” to patient safety, particularly those involving opioids, which are high-risk medicines, and that the risk is amplified in older patients who have multiple health issues and are taking numerous medications.

Chief Executive Officer Palliative Care Australia, Liz Callaghan says the peak body supports advances that assist the quality of palliative care offered in Australia, especially when it comes to medication administration.

“Palliative Care Australia supports all services moving to electronic medication charts in order to minimise medication errors, and supports further studies that contribute to understanding the factors leading to opioid errors,” Ms Callaghan says.

“[We] support the continued systematic approach to monitoring medication errors while encouraging a culture of quality improvement [as well as] ongoing training of health professionals in opioid prescribing and administration and utilisation of the clinical pharmacist to their full scope of practice within the palliative care team.”