1 Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
2 London School of Hygiene & Tropical Medicine, London, UK.
Palliat Med. 2019 Mar;33(3):346-356. doi: 10.1177/0269216318817692. Epub 2018 Dec 12.
: Patients receiving palliative care are often at increased risk of unsafe care with the out-of-hours setting presenting particular challenges. The identification of improved ways of delivering palliative care outside working hours is a priority area for policymakers.
: To explore the nature and causes of unsafe care delivered to patients receiving palliative care from primary-care services outside normal working hours.
: A mixed-methods cross-sectional analysis of patient safety incident reports from the National Reporting and Learning System. We characterised reports, identified by keyword searches, using codes to describe what happened, underlying causes, harm outcome, and severity. Exploratory descriptive and thematic analyses identified factors underpinning unsafe care.
SETTING/PARTICIPANTS:: A total of 1072 patient safety incident reports involving patients receiving sub-optimal palliative care via the out-of-hours primary-care services.
: Incidents included issues with: medications (n = 613); access to timely care (n = 123); information transfer (n = 102), and/or non-medication-related treatment such as pressure ulcer relief or catheter care (n = 102). Almost two-thirds of reports (n = 695) described harm with outcomes such as increased pain, emotional, and psychological distress featuring highly. Commonly identified contributory factors to these incidents were a failure to follow protocol (n = 282), lack of skills/confidence of staff (n = 156), and patients requiring medication delivered via a syringe driver (n = 80).
: Healthcare systems with primary-care-led models of delivery must examine their practices to determine the prevalence of such safety issues (communication between providers; knowledge of commonly used, and access to, medications and equipment) and utilise improvement methods to achieve improvements in care.
接受姑息治疗的患者在非工作时间往往面临更高的不安全护理风险，而这一时间段的医疗服务尤其具有挑战性。为政策制定者确定改进非工作时间姑息治疗提供方式是当务之急。
探索在非工作时间从初级保健服务为接受姑息治疗的患者提供的不安全护理的性质和原因。
对国家报告和学习系统中的姑息治疗患者安全事件报告进行混合方法的横断面分析。我们通过关键字搜索识别报告，使用描述发生了什么、根本原因、伤害结果和严重程度的代码对报告进行分类。探索性描述性和主题分析确定了不安全护理的潜在因素。
设置/参与者：共涉及 1072 份患者安全事件报告，涉及通过非工作时间初级保健服务接受姑息治疗但效果不佳的患者。
事件包括以下问题：药物（n=613）；及时获得医疗服务（n=123）；信息传递（n=102），以及/或非药物治疗，如缓解压疮或导管护理（n=102）。近三分之二的报告（n=695）描述了伤害，例如增加疼痛、情绪和心理困扰等。这些事件常见的促成因素包括未能遵循协议（n=282）、员工技能/信心不足（n=156），以及患者需要通过注射器驱动器给药（n=80）。
以初级保健为主导的医疗服务系统必须检查其实践，以确定此类安全问题（提供者之间的沟通；常用药物和设备的知识和获取）的普遍性，并利用改进方法来改善护理。
