Nicole Heneka1, Priyanka Bhattarai1, Tim Shaw2, Debra Rowett3, Samuel Lapkin4, Jane L Phillips5. 1. 1 School of Nursing, The University of Notre Dame Australia, Darlinghurst, NSW, Australia. 2. 2 Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia. 3. 3 School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia. 4. 4 Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, Australia. 5. 5 Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
Abstract
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.
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.
Authors: Roger Flint; Deans Buchanan; Scott Jamieson; Alfred Cuschieri; Shady Botros; Joanna Forbes; Jacob George Journal: Int J Environ Res Public Health Date: 2019-05-31 Impact factor: 3.390