INJECTABLE end-of-life symptom control medication incidents may be underestimated sources of serious harm in community care.
In this mixed-methods study from England and Wales, investigators examined how often supposedly “no harm” safety incidents involving injectable end-of-life symptom control medication actually harmed patients or families. Using a random sample of 1,000 community incident reports submitted to the National Reporting and Learning System between 2017 and 2022, they identified 388 incidents that met inclusion criteria and analyzed them in depth. The focus was on community-based end-of-life care.
Characterizing Injectable End-Of-Life Symptom Control Medication Incidents
Researchers applied the PatIent SAfety Classification system to describe incident types, contributory factors and outcomes, then thematically analyzed free-text narratives. Despite all sampled records being originally coded as “no harm,” 107 reports, or 28%, were reclassified during review as harmful to patients and families. Psychological harm featured prominently, with 43 reports describing emotional distress experienced by patients and those close to them.
Conflicting Perceptions of Harm at the End of Life
When harmful and true “no harm” incidents were compared, a consistent pattern emerged. Reports reclassified as harmful more often described conflicting views between healthcare professionals and family members about symptom control, decision-making and what constituted acceptable care at the end of life. The analysis highlighted considerable variability in perceptions of harm, particularly where distress, fear or anxiety occurred without obvious physical injury.
Implications For Patient Safety and Palliative Care
The authors conclude that patient safety learning in end-of-life care should move beyond a narrow focus on physical injury alone. For injectable end-of-life symptom control medication, incident reporting systems need to better capture emotional and psychological harms experienced by patients and families. Incorporating these wider impacts into safety classifications and reviews may help teams refine communication, support and shared understanding, strengthening community-based palliative care at the end of life.
Reference: Hope I et al. Revealing the hidden harms in end-of-life care: a mixed-methods characterisation of reported safety incidents involving injectable symptom control medication. Br J Gen Pract. 2025;DOI:10.3399/BJGP.2025.0301.
