Monthly Archives: December 2013

Types of Errors in Palliative Care
Medical errors in palliative care are primarily identified in drug treatment for symptom control, particularly in opioid analgesia. It is well known that medication errors are the most prevalent type of medical errors in general.[5] So even in palliative care erroneous selection, dosage or administration of drugs can either lead to undertreatment of distressing symptoms or to intoxication, both resulting in unnecessary suffering for the patient.

In our search, we found three examples for errors leading to opioid intoxication: inadvertently administering high-dose intrathecal tramadol instead of morphine leading to myoclonus, diaphoresis, and hypotension [10]; escalating the dosage of intravenous opioids too rapidly after withdrawal from the artificial respirator, followed by sedation and respiratory depression[12]; and mixing up basal rate and bolus dose in a pump of patient-controlled analgesia, leading to lethargy of the patient.[14] Although our literature search did not yield articles on errors in the management of symptoms other than pain, it seems plausible that errors occur just as well in treating nausea, vomiting, constipation, dyspnea, delirium, or any other frequent symptom in palliative patients.

Palliative care clinicians usually encounter patients who already have been diagnosed as suffering from a specific life-limiting disease. In some cases, previous preventive or diagnostic errors of colleagues may be retrospectively detected by palliative care clinicians. The example we found was a 48-year-old patient with metastatic cervical cancer, who had shown dysplasia in a Papanicolaou test 3 years prior, which had not been followed-up or prompted a colposcopy because the treating physician moved away and the communication to the new doctor was apparently insufficient.

For Relevance, Detection and Prevention of Medical Errors in Palliative Care go to Medical Errors Course