Innovative methods utilizing patient oriented bedside teaching are needed to educate physicians and health care professionals in cancer pain management. We propose to [test whether] an analgesic dosing service on an existing inpatient career unit at Northwestern Memorial Hospital [will improve physician knowledge and patient comfort]. All patients admitted to the 32 bed oncology unit of Northwestern University will undergo an admission and pain assessments each shift using a visual analog scale, by nursing, as part of daily bedside charting. All patients noted to have pain as indicated by the doorside charting or who have any analgesic order written, will be followed by the analgesic dosing service. The service will be run from the pharmacy located on the unit in concert with already identified [physician] faculty members who have a particular interest in pain management. The analgesic dosing service will be responsible for evaluating analgesic doses, route of administration of analgesics prescribed, appropriate conversions of patients' home analgesic therapies to in-hospital therapies (e.g., conversion from oral to IV medication) evaluation for appropriate breakthrough medications and use of co- analgesics and appropriate treatment of side effects. All patients will undergo daily evaluation by the dosing service. If instructions/suggestions by the analgesic dosing service pharmacist/physician team do not result in improved pain management as judged by the visual analog scale evaluations, the patient will be seen by one of the pain management faculty members. [From daily problem oriented instruction on their patients as well as role modeling, we anticipate that housestaff will demonstrably improve their skills in pain control]. In order to further promote improved pain management, during the first week of each four to five week housestaff rotation, three seminars covering the use of equianalgesic dosing tables, principle of opioid use and treatment of side effects and appropriate use of coanalgesics, will be conducted by the pain management faculty. The pain management faculty will additionally make themselves available for consultation for any pain management related question. By providing instruction, guidance, and prompt correction [of inappropriate] intervention [s] on every patient, we hope to demonstrate significant changes in physician competence and patient comfort after institution of the program.
| Lothian, S T; Fotis, M A; von Gunten, C F et al. (1999) Cancer pain management through a pharmacist-based analgesic dosing service. Am J Health Syst Pharm 56:1119-25 |
