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- Health Care Executives and Administrators
- Palliative Care
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Journal Article > Study
Patients' perception of types of errors in palliative care—results from a qualitative interview study.
Kiesewetter I, Schulz C, Bausewein C, Fountain R, Schmitz A. BMC Palliat Care. 2016;15:75.
Adverse events in palliative care differ from those in other environments. This qualitative interview study of patients who received palliative care identified errors specific to this setting, including deviation from a patient's advance directive and error in prognosis. A recent WebM&M commentary discussed challenges to implementing advance directives.
Journal Article > Study
"Please describe from your point of view a typical case of an error in palliative care": qualitative data from an exploratory cross-sectional survey study among palliative care professionals.
Dietz I, Plog A, Jox RJ, Schulz C. J Palliat Med. 2014;17:331-337.
This survey of palliative care workers in Germany sought to identify common medical errors in this setting. The majority of errors were related to communication, system failures, and medication administration, including opioid overdose.
Cases & Commentaries
SNFs: Opening the Black Box
- Web M&M
Joseph G. Ouslander, MD, and Alice Bonner, PhD, GNP; December 2013
Following a lengthy hospitalization, an elderly woman was admitted to a skilled nursing facility for further care, where staff expressed concern about the complexity of the patient's illness. A few days later, the patient developed a fever and shortness of breath, prompting readmission to the acute hospital.
Journal Article > Study
Failure to engage hospitalized elderly patients and their families in advance care planning.
- Classic
Heyland DK, Barwich D, Pichora D, et al; ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team; Canadian Researchers at the End of Life Network (CARENET). JAMA Intern Med. 2013;173:778-787.
Advance care planning (ACP) has become an increasingly utilized process for exploring and communicating patients' preferences for end-of-life care. This multicenter audit of ACP practices across 12 hospitals in Canada found that even when patients and families have completed ACP, inpatient health care providers are not discussing these preferences during hospitalization nor are they documenting these decisions in the medical record. When there was chart documentation, it did not match the patients' expressed wishes more than two-thirds of the time. The majority of audited cases found that patients were prescribed more aggressive care than they would have preferred. An accompanying editorial argues that these types of "silent misdiagnoses" should be considered medical errors, noting that discussions about code status and ACP are "every bit as important to patient safety as a central line placement or a surgical procedure." A previous AHRQ WebM&M commentary discussed ACP and other tools for expressing end-of-life preferences.
Journal Article > Study
Errors in palliative care: kinds, causes, and consequences: a pilot survey of experiences and attitudes of palliative care professionals.
Dietz I, Borasio GD, Med DP, et al. J Palliat Med. 2013;16:74-81.
Patients receiving palliative care can be medically complex and often require medications considered high-risk (such as opioid pain medications). These factors are known to be associated with an increased risk of medical errors, but thus far, few studies have examined patient safety risks in palliative care patients. This survey of palliative medicine physicians in Germany found that most considered errors to be a significant problem in palliative care, and respondents cited medication errors and errors related to communication as the most common types of patient safety problems in the field. An AHRQ WebM&M case discusses a preventable adverse event that occurred in a palliative care patient.
Journal Article > Study
Modern palliative radiation treatment: do complexity and workload contribute to medical errors?
D'Souza N, Holden L, Robson S, et al. Int J Radiat Oncol Biol Phys. 2012;84:e43-e48.
More complex treatments and increased provider workload were associated with errors in palliative radiation treatment.
Journal Article > Review
Medical errors and patient safety in palliative care: a review of current literature.
Dietz I, Borasio GD, Schneider G, Jox RJ. J Palliat Med. 2010;13:1469-1474.
Finding limited research on patient safety in palliative care, this review highlights the need for better definitions of medical errors in this setting.