A review of medication errors involving opioids in palliative care has found under-dosing may be contributing to the burden of the pain of terminally ill patients in the last weeks of their lives.
In a paper published in British Medical Journal Supportive and Palliative Care on Monday, researchers from NSW and the University of South Australia found errors involving opioids are almost three times higher than previously reported in other healthcare settings.
The most common types of errors were missed doses and wrong doses.
More than half of the errors (57 per cent) involved patients receiving a lower dose of pain relief than ordered, requiring clinical intervention in a third of cases, the study found.
The researchers looked at opioid errors in three inpatient palliative care services in metropolitan NSW.
The study found the errors adversely impacted on pain and symptom managementin 42 per cent of patients, with more than half of them requiring additional treatment as a direct consequence of the opioid error.
The majority of patients examined had terminal cancer and were aged in their 70s.
Opioids are a high-risk medicine frequently used to manage palliative patients' cancer-related pain and other symptoms. But researchers found that, despite the high volume of use in inpatient palliative care services, few studies have focused on opioid errors in this population.
Professor Debra Rowett of the University of South Australia's School of Pharmacy and Medical Sciences said the study highlighted the importance of understanding why opioid errors occur - particularly lower dosing, which can contribute to the pain of terminally ill patients.
"Palliative care clinicians have identified that safe use of opioids is a patient safety priority and this study is an important first step in quantifying and identifying opioid errors," Professor Rowett said.
"The high rate of errors in palliative care environments compared to other healthcare services most likely reflects the higher volume of opioids such as morphine being used for patients to manage their pain in the last stages of their lives."
Of the 55 opioid errors identified, most involved morphine dosages (35 per cent) while two thirds related to administration errors.
The researchers argued better understanding the factors that contribute to or mitigate opioid errors must be a priority in a palliative care.
The researchers added medication errors posed one of the greatest risks to patient safety, particularly those involving opioids, which are high-risk medicines.
The risk is amplified in patients who are older, have multiple health issues and are taking numerous medications, the study said.
It also found medication errors are consistently under-reported, making it conceivable that theactual number of medication errors may have been much higher than those reported.
