{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T02:07:00Z","timestamp":1778810820851,"version":"3.51.4"},"reference-count":51,"publisher":"Royal College of General Practitioners","issue":"764","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"accepted":{"date-parts":[[2025,9,16]]},"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Many patients dying in the community are prescribed injectable medications and are vulnerable to unsafe care. Developing safer and effective healthcare systems requires learning from patient safety incidents, including those resulting in no harm or near misses, however, health systems typically, must prioritise learning from harmful incidents because of resource constraints and are at risk of missing key learning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To appraise the nature and outcomes of reported \u2018no harm\u2019 injectable end-of-life symptom control medication incidents, and understand the characteristics of those incidents and how they differ from those reclassified during the study analysis as \u2018harmful\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>This was a mixed-methods analysis of nationally reported (England and Wales) patient safety incidents to the National Reporting and Learning System involving injectable end-of-life symptom control medications in the community.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A random sample of 1000 incidents reported as \u2018no harm\u2019 incidents submitted between 2017 and 2022 was screened. The PatIent SAfety (PISA) classification system was used to characterise incident type, contributory factors, reported harms, and outcomes, with subsequent thematic analysis of free-text narratives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 388 incidents were included. Of these, 107 (28%) reports described harm to patients and families including 43 that detailed psychological harms. Comparing incidents reclassified as harmful with the true \u2018no harm\u2019 incidents, the harmful incidents contained more conflicting views between professionals and family members and there was clear variability in perceptions of what constitutes a harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Healthcare teams need to incorporate the impact on the patient and families when reporting and learning from end-of-life symptom control incidents, notably resultant emotional and psychological harms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3399\/bjgp.2025.0301","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T13:01:26Z","timestamp":1763989286000},"page":"e234-e243","source":"Crossref","is-referenced-by-count":3,"title":["Revealing the hidden harms in end-of-life care: a mixed-methods characterisation of reported safety incidents involving injectable symptom control medication"],"prefix":"10.3399","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3313-4801","authenticated-orcid":false,"given":"Isabel","family":"Hope","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6772-2620","authenticated-orcid":false,"given":"Ben","family":"Bowers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isobel J","family":"McFadzean","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Yardley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristian","family":"Pollock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart","family":"Hellard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Carson-Stevens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1987","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"2026031009301573000_76.764.e234.1","unstructured":"Royal College of General Practitioners (RCGP) (2016) The RCGP position statement on palliative and end of life care (RCGP), accessed. https:\/\/www.rcgp.org.uk\/getmedia\/916e61b5-b3a7-4300-b5f4-de9828af2325\/RCGP-EOLC-Position-Statement_FINAL.pdf. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.2","unstructured":"Johansson T Pask S Goodrich J (2024) Time to care: findings from a nationally representative survey of experiences at the end of life in England and Wales (Marie Curie), accessed. https:\/\/www.mariecurie.org.uk\/globalassets\/media\/documents\/policy\/beol-reports-2024\/beol-2024-time-to-care-report.pdf. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2024.104734"},{"key":"2026031009301573000_76.764.e234.4","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211043382"},{"key":"2026031009301573000_76.764.e234.5","doi-asserted-by":"publisher","DOI":"10.1177\/0269216318815796"},{"key":"2026031009301573000_76.764.e234.6","unstructured":"Scobie S Julian S Bagri S Davies M (2024) What primary and community services do people who die at home receive (Nuffield Trust), accessed. https:\/\/www.nuffieldtrust.org.uk\/news-item\/end-of-life-care-blog. 19 Dec 2024."},{"key":"2026031009301573000_76.764.e234.7","unstructured":"Victoria State Government Department of Health (2017) Anticipatory medicines (Victoria State Government), accessed. https:\/\/www.health.vic.gov.au\/patient-care\/anticipatory-medicines. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.8","unstructured":"Brisbane South Palliative Care Collaborative (2025) Community-based palliative care anticipatory medicines: guidance for Queensland (Brisbane South Palliative Care Collaborative), accessed. https:\/\/www.health.qld.gov.au\/__data\/assets\/pdf_file\/0010\/1310113\/s1215_pallconsult_medicinesguidelines_web.pdf. 13 Jan 2026."},{"key":"2026031009301573000_76.764.e234.9","unstructured":"National Institute for Health and Clinical Excellence (NICE) (2015) Care of dying adults in the last days of life - NICE guideline: NG31 (NICE), accessed. https:\/\/www.nice.org.uk\/guidance\/ng31. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.10","unstructured":"Healthcare Improvement Scotland (2025) Scottish palliative care guidelines: anticipatory prescribing (NHS Scotland), accessed. https:\/\/rightdecisions.scot.nhs.uk\/scottish-palliative-care-guidelines\/anticipatory-prescribing\/. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.11","doi-asserted-by":"publisher","DOI":"10.1136\/spcare-2022-004080"},{"key":"2026031009301573000_76.764.e234.12","unstructured":"Independent Review of the Liverpool Care Pathway (2013) More care, less pathway: a review of the Liverpool Care Pathway (Independent Review of the Liverpool Care Pathway), accessed. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/212450\/Liverpool_Care_Pathway.pdf. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.13","unstructured":"Gosport Independent Panel (2018) Gosport War Memorial Hospital: the Report of the Gosport Independent Panel (Department of Health), accessed. https:\/\/www.gosportpanel.independent.gov.uk\/media\/documents\/070618_CCS207_CCS03183220761_Gosport_Inquiry_Whole_Document.pdf. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.14","unstructured":"World Health Organization (WHO) (2021) Global patient safety action plan 2021-2030- towards eliminating avoidable harm in health care (WHO), accessed. https:\/\/www.who.int\/publications\/i\/item\/9789240032705. Jan 2026."},{"key":"2026031009301573000_76.764.e234.15","unstructured":"NHS Improvement (2018) Developing a patient safety strategy for the NHS: proposals for consultation (NHS Improvement), accessed. https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2023\/07\/Developing-A-Patient-Safety-Strategy-for-the-NHS-14-Dec-2018-v2.pdf. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.16","doi-asserted-by":"publisher","DOI":"10.3310\/hsdr04270"},{"key":"2026031009301573000_76.764.e234.17","unstructured":"Heinrich HW (1980) Industrial prevention: a safety management approach (McGraw-Hill, New York)."},{"key":"2026031009301573000_76.764.e234.18","doi-asserted-by":"publisher","DOI":"10.1097\/NNA.0000000000001124"},{"key":"2026031009301573000_76.764.e234.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2010.01.006"},{"key":"2026031009301573000_76.764.e234.20","unstructured":"NHS England (2023) The Learn from Patient Safety Events (LFPSE) Service-patient and family discovery report (NHS England), accessed. https:\/\/www.england.nhs.uk\/long-read\/the-learn-from-patient-safety-events-lfpse-service\/. 10 Mar 2025."},{"key":"2026031009301573000_76.764.e234.21","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004732"},{"key":"2026031009301573000_76.764.e234.22","unstructured":"Panagioti M Khan K Keers R (2017) Preventable patient harm across health care services: a systematic review and meta-analysis (understanding harmful care) a report for the general medical council (GMC), accessed. https:\/\/www.gmc-uk.org\/cdn\/documents\/preventable-patient-harm-across-health-care-services_pdf-73538295.pdf. 15 Dec 2025."},{"key":"2026031009301573000_76.764.e234.23","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01774-9"},{"key":"2026031009301573000_76.764.e234.24","doi-asserted-by":"publisher","DOI":"10.1177\/0269216318817692"},{"key":"2026031009301573000_76.764.e234.25","doi-asserted-by":"publisher","DOI":"10.1177\/02692163241288774"},{"key":"2026031009301573000_76.764.e234.26","doi-asserted-by":"publisher","DOI":"10.1177\/0269216318776846"},{"key":"2026031009301573000_76.764.e234.27","unstructured":"NICE (2004) Guidance on cancer services: improving supportive and palliative care for adults with cancer. The manual (NICE), accessed. https:\/\/www.nice.org.uk\/guidance\/csg4\/resources\/improving-supportive-and-palliative-care-for-adults-with-cancer-pdf-773375005. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.28","unstructured":"World Health Organization (WHO) (2020) Palliative care. Fact sheet (WHO), accessed. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/palliative-care. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.29","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.17.199802"},{"key":"2026031009301573000_76.764.e234.30","doi-asserted-by":"publisher","DOI":"10.1177\/02692163241287639"},{"key":"2026031009301573000_76.764.e234.31","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c4587"},{"key":"2026031009301573000_76.764.e234.32","unstructured":"NHS England (2024) Policy guidance on recording patient safety events and levels of harm (NHS England), accessed. https:\/\/www.england.nhs.uk\/long-read\/policy-guidance-on-recording-patient-safety-events-and-levels-of-harm\/. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.33","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-048696"},{"key":"2026031009301573000_76.764.e234.34","unstructured":"WHO (2009) Conceptual framework for the International Classification for Patient Safety (WHO), accessed. https:\/\/www.who.int\/publications\/i\/item\/WHO-IER-PSP-2010.2. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.35","unstructured":"NHS England (2019) National reporting and learning system: degree of harm FAQs (NHS), accessed. https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2019\/10\/NRLS_Degree_of_harm_FAQs_-_final_v1.1.pdf. 19 Dec 2025."},{"key":"2026031009301573000_76.764.e234.36","unstructured":"Braun V Clarke V (2013) Successful qualitative research: a practical guide for beginners (Sage, London)."},{"key":"2026031009301573000_76.764.e234.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2009.09.052"},{"key":"2026031009301573000_76.764.e234.38","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39031.507153.AE"},{"key":"2026031009301573000_76.764.e234.39","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2008.029496"},{"key":"2026031009301573000_76.764.e234.40","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0b013e3181fd1697"},{"key":"2026031009301573000_76.764.e234.41","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-013524"},{"key":"2026031009301573000_76.764.e234.42","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2016-005476"},{"key":"2026031009301573000_76.764.e234.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2020.02.004"},{"key":"2026031009301573000_76.764.e234.44","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2024-017918"},{"key":"2026031009301573000_76.764.e234.45","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-022-00731-5"},{"key":"2026031009301573000_76.764.e234.46","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1522554"},{"key":"2026031009301573000_76.764.e234.47","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2025-QSHU.169"},{"key":"2026031009301573000_76.764.e234.48","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2019.103971"},{"key":"2026031009301573000_76.764.e234.49","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocz146"},{"key":"2026031009301573000_76.764.e234.50","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocaa082"},{"key":"2026031009301573000_76.764.e234.51","doi-asserted-by":"publisher","DOI":"10.3233\/978-1-61499-890-7-139"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/BJGP.2025.0301","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T20:31:02Z","timestamp":1773261062000},"score":1,"resource":{"primary":{"URL":"http:\/\/bjgp.org\/lookup\/doi\/10.3399\/BJGP.2025.0301"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":51,"journal-issue":{"issue":"764","published-online":{"date-parts":[[2026,2,26]]},"published-print":{"date-parts":[[2026,3,1]]}},"alternative-id":["10.3399\/BJGP.2025.0301"],"URL":"https:\/\/doi.org\/10.3399\/bjgp.2025.0301","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]}}}