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...
Bhattarai, P, Newton-John, TRO & Phillips, JL 2018, 'Quality and Usability of Arthritic Pain Self-Management Apps for Older Adults: A Systematic Review.', Pain Medicine, vol. 19, no. 3, pp. 471-484.View/Download from: UTS OPUS or Publisher's site
To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to self-manage their arthritic pain.A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool.Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N = 3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2).Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self-Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors.
Bhattarai, P & Phillips, JL 2017, 'The role of digital health technologies in management of pain in older people: An integrative review.', Archives of Gerontology and Geriatrics, vol. 68, pp. 14-24.View/Download from: UTS OPUS or Publisher's site
Pain is one of the most distressing and debilitating health issues faced by older people. The burden of unrelieved pain experienced by older people and its associated high symptom and economic costs demands consideration of new strategies to better this condition. As the global uptake of digital technology increases, exploring its potential to impact positively on older peoples' pain self-management practices warrants investigation. This integrative review aimed to evaluate the use of digital health technology for management of older people's pain across care-settings. Searches were conducted to identify relevant English language studies published in CINHAL, Medline, Academic Search Complete, EMBASE, Cochrane library databases, and Google and Google Scholar websites. A total of 1003 papers were identified, 9 met the inclusion criteria. The highest level of evidence (Level II) was generated by three Phase II randomized controlled trials. These trials demonstrated the feasibility of computer based interactive or instructive video interventions however there was limited evidence to support their use for reduction of pain intensity and interference. Qualitative evidence demonstrated older people's willingness to use mobile technologies (iPhone or digital pen) to help manage their pain, however, the need of device-use training and connectedness with clinicians were highlighted. In conclusion, there is some evidence that integrating digital health technology into older peoples' pain self-management plan is feasible and acceptable. However, the provision of high-quality technological interventions informed by a thorough understanding of older people's digital technology pain management needs is required to ensure greater integration of this technology in clinical practice.
Luckett, T, Phillips, J, Johnson, MJ, Farquhar, M, Swan, F, Assen, T, Bhattarai, P & Booth, S 2017, 'Contributions of a hand-held fan to self-management of chronic breathlessness.', The European Respiratory Journal, vol. 50, no. 2, pp. 1-10.View/Download from: UTS OPUS or Publisher's site
This study explored the benefits of a hand-held fan as perceived by patients with chronic breathlessness and their carers.A secondary multimethod analysis was conducted of interview data collected in three clinical trials. Two researchers independently coded level of benefit qualitatively reported by each patient. Univariate and multivariate statistics were used to explore perceived benefit as a factor of sex, age and diagnosis. Qualitative analysis used an integrative method.133 patients commented on the fan, of whom 72 had a carer. Diagnoses included nonmalignant (n=91, 68.4%) and malignant (n=21, 15.8%) conditions. Of 111 patients who provided codable data, four (3.6%) perceived no benefit, 16 (14.4%) were uncertain, 80 (72.0%) perceived some benefit and 11 (10.0%) perceived very substantial benefit. Multivariate analysis was inconclusive. Benefit was described in terms of shorter recovery time, especially after activity. 10 (7.5%) patients said the fan reduced their need for home oxygen or inhaled β-agonist medications. Negative perceptions of a few included dislike of the cooling sensation and embarrassment in public.Findings suggest that a hand-held fan is a portable intervention with few disadvantages from which most patients with chronic breathlessness will derive benefit alongside other nonpharmacological and pharmacological strategies. Research is needed to optimise guidance on fan administration.
Bhattarai, P, Hickman, L & Phillips, JL 2016, 'Pain among hospitalized older people with heart failure and their preparation to manage this symptom on discharge: a descriptive-observational study', CONTEMPORARY NURSE, vol. 52, no. 2-3, pp. 204-215.View/Download from: UTS OPUS or Publisher's site
Luckett, T, Bhattarai, P, Phillips, J, Agar, M, Currow, D, Krastev, Y & Davidson, PM 2015, 'Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria', AUSTRALIAN HEALTH REVIEW, vol. 39, no. 5, pp. 552-560.View/Download from: UTS OPUS or Publisher's site