Pain assessment and analgesic prescription for cancer patients in a medical ward: The influence of an educational intervention.

Background. Pain is present in more than 75% of patients with advanced cancer and is often under-treated. Adequate pain control is an essential component of patient care. By correctly following the WHO analgesic ladder, pain can be controlled in nearly 90% of patients with cancer. Clinical audits help to improve patient care. Hence, an audit was done on documentation of pain and prescription of analgesics in patients with cancer admitted to a medical ward. Methods. We conducted a retrospective audit of inpatient charts to assess the adequacy of documentation of pain and prescription of analgesics. Following this, we introduced an educational intervention in the form of teaching, provision of pocket guidelines and displaying a poster with the WHO analgesic guidelines. Subsequently, we conducted a prospective audit of documentation of pain and prescribing practices against the following standards: documentation of pain, intensity and response, prescription of analgesics based on WHO guidelines, prescribing breakthrough analgesics and prescribing stimulant laxatives with strong opioids. Results. The retrospective audit included 39 patients and the prospective audit had 34 patients. Pain was documented in 89.7% and 82.4%, pain intensity in 12.8% and 8.8%, and pain response in 12.8% and 11.8%, in the retrospective and prospective audits, respectively. WHO principles were correctly followed in 74.3% and 88.2%, and breakthrough analgesics prescribed in 38.4% and 61.8%, respectively. Conclusion. There was improvement in correctly following the WHO analgesic guidelines and prescribing breakthrough analgesics but not in documentation of pain. Clinical audits and interventions such as teaching, pocket guidelines and posters can result in better patient care.

Dissecting intramural hematoma in esophageal carcinoma.

A 50-year-old man with esophageal carcinoma developed severe, refractory, retrosternal chest pain. The diagnosis was made four days later when contrast studies showed an intramural dissecting hematoma of the esophagus. The patient responded to conservative management.