One unique feature of palliative care is that the harmful consequences from errors may be harder to identify than in other types of care. In palliative care, awareness of the potential for medical errors is less developed, critical incident reporting systems are rare, and empirical research on patient safety is scant.( 3) There is no reliable study on the prevalence of critical incidents (errors and near-misses) in palliative care. First, it highlights that the last phase of most people's lives is an extended period of geriatric multimorbidity.( 1) Second, it shows the difficulty of making treatment decisions for patients with chronic illnesses due to the unpredictable disease trajectory and potential prognostic uncertainty.( 2) Third, it underscores the potential for medical errors in end-of-life care and the difficulty in evaluating these errors.Ĭaring for patients at the end of their lives is demanding, necessitating an interdisciplinary and multiprofessional approach. This case beautifully illustrates the current challenges in palliative care in three ways. They wondered how best to educate providers about the balance between providing adequate pain control at or near the end of life and minimizing harm. At the same time, the review team remained sensitive to the bedside nurse's desire to relieve suffering in a patient who wanted to focus on comfort. Although the patient did not suffer and died peacefully, they believed that his life may have been shortened. In reviewing the case, the palliative care team felt that the overnight dose of hydromorphone may not have been indicated and may have been excessively large. He died peacefully with his family at the bedside. He survived for another 5 days in the hospital, requiring a few doses of intravenous hydromorphone for comfort. The patient continued to be obtunded and unarousable, but his respiratory rate and effort improved. She believed he was close to death and contacted his family, who came to see him. The following morning, the palliative care attending saw the patient at 7:00 AM and found him obtunded, with shallow respirations and a low respiratory rate. The nurse administered the scheduled dose of intravenous hydromorphone. She asked him, "Are you having any trouble breathing?" He responded, "A little bit," but he remained drowsy. The patient appeared to be sleeping but woke up when the nurse came in the room. On the night shift, the bedside nurse went to see the patient at 3:00 AM to administer the next scheduled dose of hydromorphone. Wanting to ensure the patient's comfort, the inpatient team wrote for a standing dose of intravenous hydromorphone every 4 hours. He seemed more at peace after making the decision and was able to spend time with his family. His diuretics, statins, beta-blockers, and other treatments for his heart failure were stopped. While he was still hospitalized, comfort measures were initiated. His life expectancy was believed to be weeks to months, based on his comorbidities and frailty. In discussions with the patient and his son, the patient expressed that he would like to focus on comfort and pursue hospice care. During this admission, he improved slightly with treatment, but his overall prognosis remained poor. It was his third admission in the previous 4 weeks. Recognize the principle of double effect and the implications for potential medication errors.Īn 83-year-old man with chronic kidney disease and end-stage congestive heart failure (CHF) with a severely reduced ejection fraction was admitted for an exacerbation of his CHF.Describe key principles regarding the use of opioids in palliative care.State that medication errors and errors in communication are common in palliative care.Recognize errors may be difficult to identify in palliative care.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |