Better out-of-hours palliative care needed

A better understanding of risks and causes of harm for out of hours palliative care is urgently needed to ensure patient safety, finds a study carried out by researchers at Cardiff University. Funded by terminal illness charity, Marie Curie, and the RCGP, the study found that among 1,072 palliative care cases reviewed, concerns arose as a result of four main issues requiring improvement: errors in medication provision; securing access to timely care; inefficient transfer of information between healthcare teams; and problems with non-medication based treatments like urinary catheters and feeding tubes. In the study, almost two thirds (64.8%) of the patient safety incidents described 'actual harm' to patients, with reports citing emotional and psychological distress to patients, families and carers. These incidents of 'harm' included errors in prescribing, dispensing or administering of medications, or delays in access to timely care or advice. Serious harm (moderate harm or worse), highlighted more serious consequences in 129 (12%) of the cases studied, such as hospital admission and untimely death. The majority of incidents reported were medication-related. Although palliative care can quickly relieve unnecessary suffering for people in their home and prevent unwanted hospital or accident and emergency admissions, which can be distressing for the patient and their family, the majority of resources go to in-hours services, with fewer staff, services and less funding for out of hours care.