Six errors causing patient harm occurred in the treatment of 425 patients in the two years prior to May 2003, according to a report reviewing medication management practices in Galway Hospice.
This is a patient harm error rate of 1.4 per cent compared to a nationally stated figure, estimated using the Harvard Medical Malpractice Study, of 4 per cent.
The inquiry by an independent expert group into 'clinical issues' at the hospice was set up last July, after a consultant in the Western Health Board, responsible for referring terminally ill patients to the centre, raised major concerns about medication procedures there.
The Western Health Board have not been making referrals to the 12-bed unit since May, 2003, and terminally ill patients are being treated in University College Hospital, Galway (UCHG).
The expert group examined 31 identified medication incidents and established that there were 28 cases of error of which six of those resulted in harm to the patient. In at least four cases, emergency intervention was necessary in order to sustain life.
All of the errors dealt with in the report were known to the hospice, and the patients and families of patients who were affected were informed by the hospice at the time. The expert group found that no errors occurred that may have contributed to or resulted in any patient's death.
The findings in the report show that the drug errors were found to be attributable to both nursing staff and medical staff.
The Galway Hospice Foundation said they accepted that systems need to be in place for identifying and dealing with all errors. The report made 65 recommendations which the Foundation said they were committed to implementing. They said under the new management structure put in place since the report was commissioned, much work has already been done towards these ends.
The completion of the review was an important stepping-stone in ensuring that referrals from the Western Health Board can recommence as early as is practicable, according to a statement released by the Hospice foundation.