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Journal Article > Review
Quantifying the burden of opioid medication errors in adult oncology and palliative care settings: a systematic review.
Heneka N, Shaw T, Rowett D, Phillips JL. Palliat Med. 2016;30:520-532.
Opioids are commonly used to manage pain in patients with cancer and those near the end of life. Although opioids offer many therapeutic benefits, they are also a known high-risk medication. Deaths due to inadvertent opioid overdose are a major patient safety issue in ambulatory care, and this review sought to quantify how often opioids were implicated in adverse drug events in oncology and palliative care patients. Despite a broad literature search, the authors identified only a few relevant studies, most of which examined errors associated with opioid prescribing in hospitalized patients. As a result, it was not possible to estimate the incidence of opioid-related medication errors in this population. This lack of data hinders better understanding of the balance between risks and benefits of opioids in ambulatory care patients, which is very important given how frequently opioids are used for cancer pain. The AHRQ Health Care Innovations Exchange offers tools for organizations seeking to optimize opioid prescribing. A WebM&M commentary discussed a case of a death due to an unintentional opioid overdose.
Journal Article > Review
Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis.
Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. JAMA Intern Med. 2016;176:958-968.
This systematic review examined randomized trials of opioid medications for back pain. Investigators found that a significant proportion of trial participants reported adverse effects and that recommended opioid doses only resulted in a small and short-term decrease in pain, which is deemed clinically insignificant. These results support the recent Centers for Disease Control and Prevention recommendation against the use of opioids for chronic nonmalignant pain.
Journal Article > Commentary
Clinicians' perceptions of medication errors with opioids in cancer and palliative care services: a priority setting report.
Heneka N, Shaw T, Azzi C, Phillips JL. Support Care Cancer. 2018;26:3315-3318.
This commentary explored organizational opioid incident review experiences from six hospitals in Australia to set priorities for improvement. The authors determined where process errors occurred, reviewed what factors were involved, and discussed error reduction strategies. They suggest their findings can inform future opioid safety efforts for oncology and palliative care patients.
Journal Article > Study
Clinicians' perceptions of opioid error–contributing factors in inpatient palliative care services: a qualitative study.
Heneka N, Bhattarai P, Shaw T, Rowett D, Lapkin S, Phillips JL. Palliat Med. 2019;33:430-444.
This focus group study of Australian palliative care providers examined risk factors for opioid errors among palliative patients. They identified clinician inexperience, the drug preparation environment, and poor communication as contributory factors for medication errors. The authors conclude that multiple interventions will be needed to enhance opioid safety in palliative care.