Heneka, N., Shaw, T., Azzi, C. & Phillips, J.L. 2018, 'Clinicians' perceptions of medication errors with opioids in cancer and palliative care services: a priority setting report.', Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer.View/Download from: Publisher's site
This paper reports the findings of a priority setting process, undertaken with cancer and palliative care clinicians, to better understand the characteristics of medication errors with opioids within their services. Participants representing six public hospitals in one Australian state took part in a series of priority setting workshops and, drawing on actual incidents occurring in their services, sought to identify where in the opioid medication process errors were most frequently occurring. Opioid error types and perceived contributing factors were explored, and strategies to reduce/prevent opioid errors were proposed. The priority setting process provided valuable insights into the types of opioid errors that occur in cancer and palliative care services and the complexity of addressing opioid errors from the clinician's perspective. The findings from this priority setting process will inform future targeted quality improvement initiatives to support safe opioid medication practices in cancer and palliative care services.
Heneka, N., Shaw, T., Rowett, D., Lapkin, S. & Phillips, J.L. 2018, 'Opioid errors in inpatient palliative care services: a retrospective review.', BMJ supportive & palliative care, vol. 8, no. 2, pp. 175-179.View/Download from: Publisher's site
Opioids are a high-risk medicine frequently used to manage palliative patients' cancer-related pain and other symptoms. Despite the high volume of opioid use in inpatient palliative care services, and the potential for patient harm, few studies have focused on opioid errors in this population.To (i) identify the number of opioid errors reported by inpatient palliative care services, (ii) identify reported opioid error characteristics and (iii) determine the impact of opioid errors on palliative patient outcomes.A 24-month retrospective review of opioid errors reported in three inpatient palliative care services in one Australian state.Of the 55 opioid errors identified, 84% reached the patient. Most errors involved morphine (35%) or hydromorphone (29%). Opioid administration errors accounted for 76% of reported opioid errors, largely due to omitted dose (33%) or wrong dose (24%) errors. Patients were more likely to receive a lower dose of opioid than ordered as a direct result of an opioid error (57%), with errors adversely impacting pain and/or symptom management in 42% of patients. Half (53%) of the affected patients required additional treatment and/or care as a direct consequence of the opioid error.This retrospective review has provided valuable insights into the patterns and impact of opioid errors in inpatient palliative care services. Iatrogenic harm related to opioid underdosing errors contributed to palliative patients' unrelieved pain. Better understanding the factors that contribute to opioid errors and the role of safety culture in the palliative care service context warrants further investigation.
Phillips, J.L., Lobb, E., Mohacsi, P., Heneka, N. & Currow, D. 2017, 'Identifying systems barriers that may prevent bereavement service access to bereaved carers: A report from an Australian specialist palliative care service', Collegian.View/Download from: UTS OPUS or Publisher's site
© 2017 Australian College of Nursing Ltd. Background: Bereavement follow up is an integral element of palliative care. However, little is known about the systems that link bereavement services with bereaved carers. Aim: To map how effectively a specialist palliative care service linked bereavement service to bereaved carers. Methodology: A retrospective medical audit, using process mapping was undertaken within one Australian specialist palliative care service to identify the systems that linked bereavement services to a consecutive cohort of palliative care decedents (n=60) next of kin. Results: Bereavement records were located for 80% of decedents. Nearly all (98%) had a nominated next of kin, with just over half (54%) of those nominated contacted by bereavement services. Incomplete or missing contact details was the main reason (75%) that the bereavement service was unable to contact the decedents' next of kin. Conclusion: Having access to a designated bereavement service can ensure that bereaved next of kin are contract routinely and in a timely way. However the effectiveness of this type of service is dependent upon the bereavement service having access to all relevant contact information. There are numerous opportunities to refine and strengthen the recording of palliative care next of kin details to optimize follow up.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2017, 'Can A Complex Online Intervention Improve Cancer Nurses' Pain Screening and Assessment Practices? Results from a Multicenter, Pre-post Test Pilot Study.', Pain Management Nursing, vol. 18, no. 2, pp. 75-89.View/Download from: UTS OPUS or Publisher's site
Unrelieved cancer pain has an adverse impact on quality of life. While routine screening and assessment forms the basis of effective cancer pain management, it is often poorly done, thus contributing to the burden of unrelieved cancer pain. The aim of this study was to test the impact of an online, complex, evidence-based educational intervention on cancer nurses' pain assessment capabilities and adherence to cancer pain screening and assessment guidelines. Specialist inpatient cancer nurses in five Australian acute care settings participated in an intervention combining an online spaced learning cancer pain assessment module with audit and feedback of pain assessment practices. Participants' self-perceived pain assessment competencies were measured at three time points. Prospective, consecutive chart audits were undertaken to appraise nurses' adherence with pain screening and assessment guidelines. The differences in documented pre-post pain assessment practices were benchmarked and fed back to all sites post intervention. Data were analyzed using inferential statistics. Participants who completed the intervention (n = 44) increased their pain assessment knowledge, assessment tool knowledge, and confidence undertaking a pain assessment (p < .001). The positive changes in nurses' pain assessment capabilities translated into a significant increasing linear trend in the proportion of documented pain assessments in patients' charts at the three time points ((2) trend = 18.28, df = 1, p < .001). There is evidence that learning content delivered using a spaced learning format, augmented with pain assessment audit and feedback data, improves inpatient cancer nurses' self-perceived pain screening and assessment capabilities and strengthens cancer pain guideline adherence.
Heneka, N., Shaw, T., Rowett, D. & Phillips, J.L. 2016, 'Quantifying the burden of opioid medication errors in adult oncology and palliative care settings: A systematic review', Palliative Medicine, vol. 30, no. 6, pp. 520-532.View/Download from: UTS OPUS or Publisher's site
Phillips, J.L., Heneka, N.A., Hickman, L., Lam, L. & Shaw, T. 2014, 'Impact of a novel online learning module on specialist palliative care nurses' pain assessment competencies and patients' reports of pain: Results from a quasi-experimental pilot study', Palliative Medicine, vol. 28, no. 6, pp. 521-529.View/Download from: UTS OPUS or Publisher's site
Background: Pain is a complex multidimensional phenomenon moderated by consumer, provider and health system factors. Effective pain management cuts across professional boundaries, with failure to screen and assess contributing to the burden of unrelieved pain.
Heneka, N., Phillips, J.L., Rowett, D. & Shaw, T. 2015, 'Identifying opioid medication error types, incidence and patient impact in adult oncology and palliative care settings: a systematic review', Asia-Pacific Journal of Clinical Oncology, pp. 128-128.View/Download from: UTS OPUS
Phillips, J.L., Heneka, N., Lam, L. & Shaw, T. 2014, 'A complex Qstream (R) pain assessment intervention on cancer nurses' pain screening and assessment practices: results from a quasi-experimental study', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 136-136.
Phillips, J.L., Heneka, N., Lam, L.T. & Shaw, T. 2014, 'Multi-Centre Pre-Post Test Trial of a complex Qstream (C) pain assessment intervention on cancer nurses' pain screening and assessment practices', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 206-206.
Phillips, J.L., Heneka, N. & Hickman, L. 2014, 'Impact of a Qstream online learning module on palliative care nurses' pain assessment competencies and patients' report on pain: Results from a quasi-experimental pilot study', Asia Pacific Journal of Clinical Oncology, Wiley: 12 months.View/Download from: UTS OPUS
Phillips, J., Heneka, N. & Shaw, T. 2013, 'EXPLORING OPIATE ERRORS IN THE SPECIALIST CANCER AND PALLIATIVE CARE SETTING: PERCEPTIONS OF KEY STAKEHOLDERS', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 127-127.
Phillips, J., Heneka, N. & Shaw, T. 2013, 'MAPPING CANCER PAIN SCREENING, ASSESSMENT AND REASSESSMENT PRACTICES WITHIN ONE AUSTRALIAN HEALTH DISTRICT: RESULTS FROM A BASELINE CHART AUDIT', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, pp. 126-127.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2013, 'Can a novel on-line pain assessment learning module improve specialist palliative care nurse's pain assessment knowledge?: Results from a pilot Spaced Education initiative', 16th CNSA Winter Congress, Brisbane Convention and Exhibition Centre, Queensland.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2012, 'Spaced Education in the Specialist Palliative Care Setting: exploring it's potential to improve pain management', 4th Biennial Palliative Care Nurses Australia Conference, Melbourne.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2013, 'The impact of a novel, online learning module on specialist palliative care nurses' pain assessment knowledge and practices', European Journal of Palliative Care, European Palliative Care Association Conference, Prague.
Phillips, J.L., Heneka, N., Hickman, L., Lam, L. & Shaw, T. 2012, 'Enhancing interdisciplinary team pain assessment communication: Can Spaced Education improve comprehensive pain assessment practices in the specialist palliative care setting?', Palliative Care NSW State Conference, Dubbo.
Phillips, J.L., Hickman, L., Heneka, N. & Shaw, T. 2012, 'Assessing specialist palliative care nurses pain assessment capabilities: identifying opportunities to improve patient outcomes', 16th Cancer Nurses Society Australia Conference, Hobart.