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Current status of palliative care team efforts in Kobe City General Hospital
European Journal of Pain Supplements 1 (2007) 82 www.EuropeanJournalPain.com
Poster
Current status of palliative care team efforts in Kobe City General Hospital Takashi Nishimura *, Nami Iwata, Michiko Saito, Reiko Naya, Michio Hayashi, Kunitaka Matsuishi, Yoshishige Okuno, Nobuyuki Katakami Palliative Care Team, Kobe City General Hospital, Hyogo, Japan
1. Objective
3. Results
Our palliative care team was established in September 1999. We report the current status of activities in which the team has been involved during the 6 years and 9 months since its establishment and present issues currently facing the team.
Pain was included in reasons for requests in 241 of 247 cases. In addition, there were 8 complaints of dyspnea, 1 of cough, 1 of feeling of enlarged abdomen, 1 of general malaise, 1 of delirium, and 2 of nausea besides pain. The patient’s condition at the time of the request and the prognosis are presented in Table 1 below.
2. Methods 4. Conclusion Some of our pain control policies are as follows: (1) Making the differential diagnosis of pain the most important aspect; (2) Focusing on pain as indicated by the patient; (3) In principle, administering therapeutics orally and using the fewest possible number of drugs and lowest effective dosage; (4) Eliminating nocturnal pain first; (5) Coadministering an antiemetic drug for the prevention of nausea and vomiting associated with morphine; (6) Providing continuous subcutaneous injection of morphine when the patient is in the terminal stage of cancer complicated by ileus, etc.
Currently, the palliative care team receives an average of at least one request every week from a wide range of departments. This occasionally seems to be a lack of communication with primary physicians. At present, pulmonary physicians mainly collaborate with the team. Psychiatrists and radiologists also provide assistance. In the future, the palliative care team intends to strengthen cooperation with other specialists such as anesthetists.
Table 1 Patient’s condition at the time of the request, and prognosis Cancer notification Prescription of narcotics at the time of making the request Pain scale (6 scales) Authorization of prescription Prescription of narcotis after the request Duration until the day of confirming outcome (including a period of discharge)
Yes: 90% No: 10% Yes: 68% No: 32% Converted to oral morphine: Median: 60 (5–1,080) mg Median: 4 (1–5) Yes: 76% No: 24% Yes: 98% No: 2% Death (cancer death) 42 (0–637) days Transferred to another hospital 24 (4–414) days
* Correspondence to: Takashi Nishimura, Palliative Care Team, Kobe City General Hospital, Hyogo, Japan. 1754-3207/$32 © 2007 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.
Poster
Current status of palliative care team efforts in Kobe City General Hospital Takashi Nishimura *, Nami Iwata, Michiko Saito, Reiko Naya, Michio Hayashi, Kunitaka Matsuishi, Yoshishige Okuno, Nobuyuki Katakami Palliative Care Team, Kobe City General Hospital, Hyogo, Japan
1. Objective
3. Results
Our palliative care team was established in September 1999. We report the current status of activities in which the team has been involved during the 6 years and 9 months since its establishment and present issues currently facing the team.
Pain was included in reasons for requests in 241 of 247 cases. In addition, there were 8 complaints of dyspnea, 1 of cough, 1 of feeling of enlarged abdomen, 1 of general malaise, 1 of delirium, and 2 of nausea besides pain. The patient’s condition at the time of the request and the prognosis are presented in Table 1 below.
2. Methods 4. Conclusion Some of our pain control policies are as follows: (1) Making the differential diagnosis of pain the most important aspect; (2) Focusing on pain as indicated by the patient; (3) In principle, administering therapeutics orally and using the fewest possible number of drugs and lowest effective dosage; (4) Eliminating nocturnal pain first; (5) Coadministering an antiemetic drug for the prevention of nausea and vomiting associated with morphine; (6) Providing continuous subcutaneous injection of morphine when the patient is in the terminal stage of cancer complicated by ileus, etc.
Currently, the palliative care team receives an average of at least one request every week from a wide range of departments. This occasionally seems to be a lack of communication with primary physicians. At present, pulmonary physicians mainly collaborate with the team. Psychiatrists and radiologists also provide assistance. In the future, the palliative care team intends to strengthen cooperation with other specialists such as anesthetists.
Table 1 Patient’s condition at the time of the request, and prognosis Cancer notification Prescription of narcotics at the time of making the request Pain scale (6 scales) Authorization of prescription Prescription of narcotis after the request Duration until the day of confirming outcome (including a period of discharge)
Yes: 90% No: 10% Yes: 68% No: 32% Converted to oral morphine: Median: 60 (5–1,080) mg Median: 4 (1–5) Yes: 76% No: 24% Yes: 98% No: 2% Death (cancer death) 42 (0–637) days Transferred to another hospital 24 (4–414) days
* Correspondence to: Takashi Nishimura, Palliative Care Team, Kobe City General Hospital, Hyogo, Japan. 1754-3207/$32 © 2007 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.