Heneka, N, Bhattarai, P, Shaw, T, Rowett, D, Lapkin, S & Phillips, JL 2020, 'Mitigating opioid errors in inpatient palliative care: A qualitative study', Collegian.View/Download from: Publisher's site
© 2019 Australian College of Nursing Ltd Background: Opioids are high-risk medicines used in high doses and volumes in specialist palliative care inpatient services to manage palliative patients’ pain and other symptoms. Despite the high volume of opioid use in this care setting, serious errors with opioids are exceedingly rare. However, little is known about the factors that mitigate opioid errors in specialist palliative care inpatient services. Aim: To explore palliative care clinicians’ perceptions of factors that mitigate opioid errors in specialist palliative care inpatient services. Methods and design: A qualitative study using focus groups and semi-structured interviews. Participants and setting: Registered nurses, doctors, and/or pharmacists (‘clinicians’) who were involved with and/or had oversight of the services’ opioid delivery and/or opioid quality and safety processes, employed by one of three specialist palliative care inpatient services in metropolitan NSW. Findings: Fifty-eight participants took part in this study, three-quarters (76%) of whom were palliative care nurses. A positive opioid safety culture was central to mitigating opioid errors in specialist palliative care inpatient services. This culture of opioid safety was founded on clear and consistent safety messages from leadership, clinicians empowered to work together and practise safely, and a non-punitive approach to errors when they occurred. The clinical nurse educator was seen as pivotal to shaping, driving and reinforcing safe opioid delivery practices across the palliative care service. Conclusion: Creating and sustaining a positive opioid safety culture, and promoting non-punitive approaches to opioid error and reporting, is essential to mitigating opioid errors in the specialist palliative care inpatient setting.
Heneka, N, Bhattarai, P, Shaw, T, Rowett, D, Lapkin, S & Phillips, JL 2019, 'Clinicians' perceptions of opioid error-contributing factors in inpatient palliative care services: A qualitative study.', Palliative medicine, vol. 33, no. 4, pp. 430-444.View/Download from: UTS OPUS or Publisher's site
BACKGROUND::Opioid errors are a leading cause of patient harm and adversely impact palliative care inpatients' pain and symptom management. Yet, the factors contributing to opioid errors in palliative care are poorly understood. Identifying and better understanding the individual and system factors contributing to these errors is required to inform targeted strategies. OBJECTIVES::To explore palliative care clinicians' perceptions of the factors contributing to opioid errors in Australian inpatient palliative care services. DESIGN::A qualitative study using focus groups or semi-structured interviews. SETTINGS::Three specialist palliative care inpatient services in New South Wales, Australia. PARTICIPANTS::Inpatient palliative care clinicians who are involved with, and/or have oversight of, the services' opioid delivery or quality and safety processes. METHODS::Deductive thematic content analysis of the qualitative data. The Yorkshire Contributory Factors Framework was applied to identify error-contributing factors. FINDINGS::A total of 58 clinicians participated in eight focus groups and 20 semi-structured interviews. Nine key error contributory factor domains were identified, including: active failures; task characteristics of opioid preparation; clinician inexperience; sub-optimal skill mix; gaps in support from central functions; the drug preparation environment; and sub-optimal clinical communication. CONCLUSION::This study identified multiple system-level factors contributing to opioid errors in inpatient palliative care services. Any quality and safety initiatives targeting safe opioid delivery in specialist palliative care services needs to consider the full range of contributing factors, from individual to systems/latent factors, which promote error-causing conditions.
Phillips, JL, Heneka, N, Bhattarai, P, Fraser, C & Shaw, T 2019, 'Effectiveness of the spaced education pedagogy for clinicians' continuing professional development: a systematic review.', Medical education, vol. 53, pp. 886-902.View/Download from: UTS OPUS or Publisher's site
CONTEXT:Ensuring clinical practice reflects current evidence is challenging given the rapid proliferation of new knowledge. Changing entrenched clinical behaviours and facilitating the adoption of best practice evidence requires a range of strategies, including affordable, scalable and effective continuing professional development (CPD). Yet, identifying the CPD delivery method most likely to effectively change and improve patient outcomes is difficult given the variability in the evidence for different learning approaches. Although there is moderate level evidence for outreach education, audit and feedback, and face-to-face or online learning, little is known about the capacity of spaced education to change ineffective clinical practice(s). Spaced education harnesses the power of spacing, repetition and testing learning content to increase topic-specific knowledge. Although spaced education is widely used in undergraduate and postgraduate medical programmes, its effectiveness as a CPD delivery method that improves patient outcomes is less certain. AIM:To determine the effectiveness of the spaced education CPD programmes to change targeted clinical knowledge and practice(s) to improve patient outcomes. METHOD:A systematic review, appraising the spaced education CPD evidence generated from searching six specialist medical and psychosocial databases. Studies published in English peer-reviewed journals from 1 January, 2000 to 31 August, 2018 were eligible for inclusion. A modified Kirkpatrick four levels of evaluation framework assisted with appraising the effect of spaced education CPD interventions on clinicians and patients. RESULTS:Of the 2396 studies identified, 17 met the inclusion criteria, involving 2701 practising clinicians from multiple disciplines and specialties. Five randomised controlled trials generated level II evidence, with the remaining 12 studies generating lower levels of evidence. The majority of studies (n = 14) involved the delivery of onlin...
Phillips, JL, Heneka, N, Lovell, M, Lam, L, Davidson, P, Boyle, F, McCaffrey, N, Fielding, S & Shaw, T 2019, 'A phase III wait-listed randomised controlled trial of novel targeted inter-professional clinical education intervention to improve cancer patients' reported pain outcomes (The Cancer Pain Assessment (CPAS) Trial): study protocol.', Trials, vol. 20, no. 1.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Variations in care models contribute to cancer pain being under-recognised and under-treated in half of all patients with cancer. International and national cancer pain management guidelines are achievable with minimal investment but require practice changes. While much of the cancer pain research over the preceding decades has focused on management interventions, little attention has been given to achieving better adherence to recommended cancer pain guideline screening and assessment practices. This trial aims to reduce unrelieved cancer pain by improving cancer and palliative doctors' and nurses' ('clinicians') pain assessment capabilities through a targeted inter-professional clinical education intervention delivered to participants' mobile devices ('mHealth'). METHODS:A wait-listed, randomised control trial design. Cancer and/or palliative care physicians and nurses employed at one of the six participating sites across Australia will be eligible to participate in this trial and, on enrolment, will be allocated to the active or wait-listed arm. Participants allocated to the active arm will be invited to complete the mHealth cancer pain assessment intervention. In this trial, mHealth is defined as medical or public health practice supported by mobile devices (i.e. phones, patient monitoring devices, personal digital assistants and other wireless devices). This mHealth intervention integrates three evidence-based elements, namely: the COM-B theoretical framework; spaced learning pedagogy; and audit and feedback. This intervention will be delivered via the QStream online platform to participants' mobile devices over four weeks. The trial will determine if a tailored mHealth intervention, targeting clinicians' cancer pain assessment capabilities, is effective in reducing self-reported cancer pain scores, as measured by a Numerical Rating Scale (NRS). DISCUSSION:If this mHealth intervention is found to be effective, in addition to improving cancer pain ...
Heneka, N, Shaw, T, Azzi, C & Phillips, JL 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, vol. 26, no. 10, pp. 3315-3318.View/Download from: UTS OPUS or 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, JL 2018, 'Exploring factors contributing to medication errors with opioids in australian specialist palliative care inpatient services: A multi-incident analysis', Journal of Palliative Medicine, vol. 21, no. 6, pp. 825-835.View/Download from: UTS OPUS or Publisher's site
© 2018 Mary Ann Liebert, Inc. Background: Opioid errors have the potential to cause significant patient harm. These high-risk medications are used in high volumes in palliative care services to manage pain and other symptoms. Palliative patients are at greater risk of harm from opioid errors, as they are generally older and taking numerous medications to manage multiple comorbidities. Understanding factors contributing to opioid errors in inpatient palliative care services is a largely underexplored, yet, essential aspect of patient safety. Objective: To explore and identify the characteristics and associated contributing factors of reported opioid errors in palliative care inpatient services using a multi-incident analysis framework. Design: A multi-incident analysis of opioid errors reported over three years in two Australian specialist palliative care inpatient services. Results: A total of 78 opioid errors were reported. The majority (76%) of these errors occurred during opioid administration, primarily due to omitted dose (34%) and wrong dose (17%) errors. Eighty-five percent of reported errors reached the patient resulting in opioid underdose for over half (59%) of these patients. Over one-third (37%) of errors caused patient harm, which required clinical intervention. Error contributing factors included the following: noncompliance with policy; individual factors such as distraction; poor clinical communication systems; and workload. Conclusions: This multi-incident analysis has provided initial insights into factors contributing to opioid errors in palliative care inpatient services. Further exploration is warranted to understand palliative care clinicians' perspectives of systems, individual, and patient factors that influence safe opioid delivery processes.
Heneka, N, Shaw, T, Rowett, D, Lapkin, S & Phillips, JL 2018, 'Opioid errors in inpatient palliative care services: A retrospective review', BMJ Supportive and Palliative Care, vol. 8, no. 2, pp. 175-179.View/Download from: UTS OPUS or Publisher's site
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 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. Objectives: 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. Methods: A 24-month retrospective review of opioid errors reported in three inpatient palliative care services in one Australian state. Results: 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. Conclusion: 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, JL, Lobb, E, Mohacsi, P, Heneka, N & Currow, D 2018, 'Identifying systems barriers that may prevent bereavement service access to bereaved carers: A report from an Australian specialist palliative care service', Collegian, vol. 25, no. 1, pp. 39-43.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.
Shaw, T, Janssen, A, Barnet, S, Nicholson, J, Avery, J, Heneka, N & Phillips, J 2018, 'The CASE Methodology: A guide to developing clinically authentic case-based scenarios for online learning programs targeting evidence-based practice', Health Education in Practice: Journal of Research for Professional Learning, vol. 1, no. 1, pp. 18-31.View/Download from: UTS OPUS
Phillips, JL, Heneka, N, Hickman, L & Lam, L 2018, 'Self-Perceived Pain Assessment Knowledge and Confidence (Self-PAC) Scale for Cancer and Palliative Care Nurses: a Preliminary Validation Study.', Pain Management Nursing, vol. 19, no. 6, pp. 819-626.View/Download from: UTS OPUS or Publisher's site
BACKGROUND:Pain is highly prevalent in all health care settings, and frequently poorly managed. Effective pain management is predicated on a continuous cycle of screening, assessing, intervening and evaluating. Identifying gaps in nurses' self-perceived pain assessment competencies is an essential first step in the design of tailored interventions to embed effective pain assessment into routine clinical practice, and improve patient reported pain outcomes. Yet, few validated instruments focus on the competencies required for undertaking a comprehensive pain assessment, with most focusing on clinician's pain management competencies. AIM:To examine the validity of the 'Self-Perceived Pain Assessment Knowledge and Confidence' (Self-PAC) Scale. DESIGN:Preliminary instrument validation. SETTING:Two Australian cancer and palliative care services. PARTICIPANTS/SUBJECTS:186 cancer and palliative care nurses. METHODS:The Self-PAC Scale was administered to participants online. Factor Analyses, including Exploratory and Confirmatory, were applied to examine the structural validity, Cronbach's alpha was calculated for internal consistency. Criterion validity was investigated by comparing responses from experienced and non-experienced nurses. RESULTS:Two components resulted with a single factor structure for pain assessment confidence and a two-factor structure for the knowledge of pain assessment. The factor loading for the subscales ranged from 0.653 to 0.969, with large proportions of the variances explained by the factors. Cronbach's alpha of the subscales ranged from 0.87-0.92 and significant difference in responses were found between experienced and non-experienced nurses. CONCLUSION:Preliminary validation of the Self-PAC Scale suggests that it is a helpful instrument for assessing cancer and palliative care nurse' pain assessment competencies.
Phillips, JL, 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 (χ(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, JL 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, JL, Heneka, NA, 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, JL, 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, JL, 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, JL, 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, JL, Heneka, N, Lam, LT & 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, 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, WILEY-BLACKWELL, 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, WILEY-BLACKWELL, pp. 126-127.
Phillips, JL, 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, JL, 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, JL, 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, JL, 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, JL, 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.