CANCER PAIN EDUCATION--AN ANLGESIC DOSING SERVICE

需要利用以病人为中心的床边教学的创新方法 对医生和卫生保健专业人员进行癌症疼痛方面的教育 管理层。 我们建议[测试]是否在现有的 西北纪念医院住院就业单元[将有所改善 医生知识和病人舒适度]。所有患者都住进了32号医院 西北大学Bed肿瘤科将接受入院和 使用视觉模拟量表，通过护理，对每个班次进行疼痛评估， 每日床边图表的一部分。所有注意到有疼痛的患者 由门口的图表显示或有任何止痛药订单的人 写完后，将提供止痛药配药服务。该服务 将从位于该单位的药房与已经 确定对[医生]有特殊兴趣的教职员工 疼痛管理。止痛剂配药服务将负责 评估止痛剂的剂量、给药途径 患者家庭止痛治疗的处方和适当转换 到住院治疗(例如，从口服药物转为静脉药物治疗) 评价适当的突破性药物和联合用药 止痛药和副作用的适当治疗。所有的病人都会 由配药服务机构进行日常评估。如果 止痛药配药服务的指示/建议 药剂师/医生团队没有改善疼痛控制 根据视觉模拟评分评估，患者将被 其中一名疼痛管理教员。[从日常问题导向 对他们病人的指导以及角色建模，我们预计 家务工作人员将明显提高他们的疼痛控制技能]。 为了进一步促进改善疼痛管理，在第一次 每周四至五周家务助理轮换，三次研讨会 涵盖等止痛剂的使用剂量表，阿片类药物的使用原则 以及副作用的治疗和适当使用镇痛剂，将是 由疼痛管理学院进行。疼痛管理学院将 另外，让自己可以为任何疼痛提供咨询 与管理相关的问题。 通过提供指导、指导和迅速纠正[…] [S]对每一位患者的不当干预，我们希望证明 治疗后医生能力和患者舒适度的显著变化 该计划的制度性。

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.