Opioids, iatrogenic harm and disclosure of medical error.
The safety of patients in U.S. hospitals is a serious problem, with adverse events because of medical error affecting a significant proportion of hospitalized patients. Patients at the end of life are particularly vulnerable and are at risk of potential adverse events. This article presents a case in which opioids were rapidly titrated to neurotoxic doses in a patient who was terminally extubated. The patient was profoundly sedated and was noted to have Cheyne-Stokes breathing. The possibility of opioid-related iatrogenic harm is raised, and a discussion of what counts as medical error in these circumstances is explored. Palliative care specialists have a unique responsibility to provide guidance and establish a standard of care that clinicians should adhere to. Prevention of harm in dying patients should be a priority in the hospital setting.
Palliative Care Service, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA. cblinderman@partners.org
Craig D
CD
Blinderman
D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D030881:Disclosure / Q000592:standards*; D017809:Fatal Outcome; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care / Q000941:ethics*; D015656:Respiratory Mechanics; D014481:United States
D000701:Analgesics, Opioid