Establishment of a liaison system for continuous opioid infusion using a patient-controlled analgesia pump at home

ABSTRACT

In our medical district, home care physician-led liaison system has not yet been established for pain relief using a patient-controlled analgesia（PCA）pump. Therefore, it has been difficult to perform continuous opioid infusion at home. We investigated the liaison system based on our experience with breast cancer patients in whom oral drug administration became difficult during palliative care at home and thus continuous opioid subcutaneous infusion was started in cooperation with a palliative care hospital team and based on the discussion among home care study group physicians of the medical association. Based on the results of our study, we established the system called“Home PCA Raku-raku（Easy）Pack”that are characterized by the following：（1）opioids are prescribed by a home care physician；（2）a certified cancer pain management nurse accompanies a nurse to visit the patients’ home, assesses their conditions, and changes the drug solution；（3）the pump rental fee is paid by the home care physician, and the cost of consumables is paid by the hospital；and（4）the home care physician calculates the fee for home management of malignant tumors, and the hospital calculates the collaborative medical management fee and the visiting nursing management fee. This system was applied to 6 patients during a period of approximately 2 years. The result of a questionnaire survey for home care physicians and visiting nurse stations using this system showed that the system was generally beneficial.