German undergraduate medical students' attitudes and needs regarding medical errors and patient safety--a national survey in Germany.

INTRODUCTION: Errors in medicine and patient safety are topics with growing scientific and public attention. In undergraduate medical education, these issues are little investigated so far. The aim of this study was to collect data regarding attitudes and needs of medical students. METHODS: In a sample of 269 German medical students, data were collected using an anonymous online questionnaire. It consisted of three parts: (1) international validated questionnaire, (2) questions about the German medical education system and (3) demographic data. Data were analysed quantitatively and qualitatively. RESULTS: One-hundred sixty-seven data sets were analysed (completion rate 62%). Twenty-five percent of the respondents stated that they already had committed a medical error. Almost half of the participants reported that they had been assigned tasks they had not been qualified for (47%), or where medical errors could have happened easily (50%). Final year students showed less confidence in error disclosure compared to younger students (p < 0.001). The majority of respondents (64%) wished for more education on the issues. DISCUSSION: With regard to future curricular developments, a consideration of attitudes and needs of medical students regarding the topics of medical errors and patient safety seems necessary. A goal-directed undergraduate education can promote an open culture and can lead to safety and satisfaction for both patients and medical professionals.

"Please describe from your point of view a typical case of an error in palliative care": Qualitative data from an exploratory cross-sectional survey study among palliative care professionals.

CONTEXT: Patient safety is a concern in medicine, and the prevention of medical errors remains a challenge. The definition and understanding of an error is particularly difficult in palliative care, with scarce empirical evidence about the nature and causes of medical errors in that discipline. OBJECTIVES: This study explored incidents palliative care professionals perceive as typical errors in their practice, and descriptions of such events. METHODS: In the context of an exploratory, cross-sectional survey on errors in palliative care among professionals of palliative care institutions in Bavaria, Germany (n=168), participants described a typical case in which an error occurred. Data from free-text answers was qualitatively analyzed, and categories for areas and causes of errors were extracted. RESULTS: The questionnaire was returned by 42% (n=70) of the sample. Two-thirds of respondents (n=46, 66%) gave a free-text answer describing a typical error in palliative care. Seven potential areas for errors were identified in the qualitative analysis: drug treatment, palliative sedation, communication, care organization, treatment plan, end-of-life care, and history taking. Six categories emerged as causes of errors: miscommunication, system failure, dysfunctional attitudes, lack of knowledge, wrong use of technology, and misjudgement. CONCLUSION: Data showed that medical errors in palliative care, as seen by professionals in the field, primarily affect medication and communication, and miscommunication and system failures are perceived as the leading causes of errors. A better understanding of the characteristics of errors within palliative care and further qualitative research are warranted to prevent errors and enhance patient safety.

Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review.

BACKGROUND: Levomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care. We undertook a systematic review based on the question "What is the published evidence for the use of levomepromazine in palliative symptom control?". METHODS: To determine the level of evidence for the use of levomepromazine in palliative symptom control, and to discover gaps in evidence, relevant studies were identified using a detailed, multi-step search strategy. Emerging data was then scrutinized using appropriate assessment tools, and the strength of evidence systematically graded in accordance with the Oxford Centre for Evidence-Based Medicine's 'levels of evidence' tool. The electronic databases Medline, Embase, Cochrane, PsychInfo and Ovid Nursing, together with hand-searching and cross-referencing provided the full research platform on which the review is based. RESULTS: 33 articles including 9 systematic reviews met the inclusion criteria: 15 on palliative sedation, 8 regarding nausea and three on delirium and restlessness, one on pain and six with other foci. The studies varied greatly in both design and sample size. Levels of evidence ranged from level 2b to level 5, with the majority being level 3 (non-randomized, non-consecutive or cohort studies n = 22), with the quality of reporting for the included studies being only low to medium. CONCLUSION: Levomepromazine is widely used in palliative care as antipsychotic, anxiolytic, antiemetic and sedative drug. However, the supporting evidence is limited to open series and case reports. Thus prospective randomized trials are needed to support evidence-based guidelines.

Errors in palliative care: kinds, causes, and consequences: a pilot survey of experiences and attitudes of palliative care professionals.

BACKGROUND: Medical errors have recently been recognized as a relevant concern in public health, and increasing research efforts have been made to find ways of improving patient safety. In palliative care, however, studies on errors are scant. OBJECTIVE: Our aim was to gather pilot data concerning experiences and attitudes of palliative care professionals on this topic. METHODS: We developed a questionnaire, which consists of questions on relevance, estimated frequency, kinds and severity of errors, their causes and consequences, and the way palliative care professionals handle them. The questionnaire was sent to all specialist palliative care institutions in the region of Bavaria, Germany (n=168; inhabitants 12.5 million) reaching a response rate of 42% (n=70). RESULTS: Errors in palliative care were regarded as a highly relevant problem (median 8 on a 10-point numeric rating scale). Most respondents experienced a moderate frequency of errors (1-10 per 100 patients). Errors in communication were estimated to be more common than those in symptom control. The causes most often mentioned were deficits in communication or organization. Moral and psychological problems for the person committing the error were seen as more frequent than consequences for the patient. Ninety percent of respondents declared that they disclose errors to the harmed patient. For 78% of the professionals, the issue was not a part of their professional training. CONCLUSION: Professionals acknowledge errors-in particular errors in communication-to be a common and relevant problem in palliative care, one that has, however, been neglected in training and research.

Medical errors and patient safety in palliative care: a review of current literature.

BACKGROUND: Recently, the discussion about medical errors and patient safety has gained scientific as well as public attention. Errors in medicine have been proven to be frequent and to carry enormous financial costs and moral consequences. We aimed to review the research on medical errors in palliative care and to screen relevant literature to appreciate the relevance of safety studies to the field. METHODS: We performed a literature search using the database PubMed that cross-matched terms for palliative care with the words "errors" and "patient safety." Publications were classified according to type of study and kind of error, and empiric research results were extracted and critically assessed. RESULTS: We found 44 articles concerning medical errors in palliative care, most of which were case studies. Of these 44 articles, 16 deal with palliative care errors as a key issue, referring mostly to symptom control (n = 13). Other examples are errors in communication, prognostication, and advance care planning. There are very few empirical studies, which are mostly retrospective observational studies. DISCUSSION: Although patients in palliative care are more vulnerable to errors and their consequences, there is little theoretical or empirical research on the subject. We propose a specific definition for errors in palliative care and analyze the challenges of delineating, identifying and preventing errors in such key areas as prognostication, advance care planning and end-of-life decision-making.