Improvements to out-of-hours palliative care are urgently needed to protect people from harm and unnecessary suffering, researchers have warned.
They carried out a study reviewing 1,072 patient safety reports from a five-year period and found 613 were related to errors in medication provision.
“This is important research that highlights the urgent need for more investment”
A further 123 were down to problems accessing timely care, 102 related to inefficient transfer of information between healthcare teams, and 102 were attributed to issues with non-medication related treatment, such as pressure ulcer relief or catheter care.
Almost two-thirds of the incidents resulted in “actual harm” to patients or carers, including as increased pain and emotional and psychological distress.
Of those people who participated in the study, 129 suffered “serious harm”, such as hospital admission and untimely death.
Researchers found common contributorily factors to these incidents were failure by staff to follow protocol (282) and a lack of skills or confidence among staff (156).
The study, published in the Palliative Medicine journal, was led by Cardiff GP Dr Huw Williams and funded by Marie Curie and the Royal College of GPs. It noted that 30% of patients used an out-of-hours service in the last days of life, yet the majority of resources went into working-hour services.
Dr Williams, an honorary research fellow in the patient safety research group at Cardiff University’s school of medicine, said safety surrounding this group of patients needed to be made a bigger priority.
“You only get one chance to get people’s last days of life right, this is an opportunity to make that experience better for people,” he said.
“The reality is people don’t stop needing care after 6.30pm”
Dr Williams added that safe access to medications and treatments, more timely care at the end of life and better information transfer across care boundaries should be the focus of future improvement initiatives.
Simon Jones, director of policy and public affairs at the charity Marie Curie, said the study findings were just the tip of the iceberg.
He highlighted that lack of provision for out-of-hours palliative care had resulted in an increased need for the charity’s nursing service, which gives people living with a terminal illness access to care at home during the evenings, weekends and bank holidays.
“We know that the lack of care and support available out of hours is a huge issue across the UK,” warned Mr Jones.
“This is a segment of the health service that has been often overlooked and has not connected well enough with the emergency services, which operate 24/7,” he said.
“The reality is people don’t stop needing care after 6.30pm – they can’t switch their condition on and off depending on what time their GP, pharmacist or district nurse is available,” Mr Jones added.
He called for more focus to be placed on what care and support was available out-of-hours to ensure people could be helped at home and to avoid unnecessary hospital admissions and reduce pressure on ambulance crews.
“You only get one chance to get people’s last days of life right”
Dr Catherine Millington-Sanders, clinical lead for end-of-life care for the Royal College of GPs and Marie Curie, said: “Patients at or nearing the end of their lives are incredibly vulnerable, and they need and deserve the best possible, safe care around the clock.
“This is important research that highlights the urgent need for more investment into delivering palliative care out-of-hours in the community and to support better joined up care right across the NHS, social, community and third sector care,” she added.
The study – titled Quality improvement priorities for safer out-of-hours palliative care – was conducted by analysing data from the National Reporting and Learning System over a five-year period.
It aimed to explore the nature and causes of unsafe palliative care delivered from primary care services between 6.30pm and 8am Monday to Friday, on weekends and during bank holidays.