Hospital Pharmacy - July/August 2018 - 260

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Hospital Pharmacy 53(4)

Table 2. Baseline Characteristics in Preimplementation and Postimplementation Groups.
Preimplementation group,
n (%) (n = 30)

Characteristics
Mean age, y (SD)
Age greater than 65 y
Sex, percent male
Renal dysfunction
Hepatic dysfunction
Metastatic disease
Allergy to opioids, percent allergic
Median home opioid dose, milligram oral
morphine equivalent (interquartile range)

56.1 (10.3)
6 (20%)
12 (40%)
4 (13.3%)
2 (6.7%)
21 (70%)
7 (23.3%)
184 (212)

Postimplementation,
n (%) (n = 32)
56.0 (12.9)
6 (18.8%)
14 (43.8%)
7 (21.9%)
3 (10.3%)
12 (37.5%)
3 (10.3%)
130 (107.5)

P valuea
.97b
.9c
.77c
.39c
.62c
<.001c
.14c
.32b

a

P value <.05 indicates statistical significance.
t test.
c
Chi-square.
b

Table 3. Study Endpoints: Comparison of Preimplementation and Postimplementation of a Pain Clinical Decision Support Tool.
Preimplementation group,
n (%) (n = 30)
Attainment of analgesia at 24 h
Time to analgesia, h (SD)
Mean pain score at admission (SD)
Mean pain score over first 28 h (SD)
Frequency of pharmacy intervention
Within first 24 h
During entire admission
Mean frequency of pain assessment in first 24 h (IQR)
NCCN guideline-adherent pain regimen, n (%)

Postimplementation group,
n (%) (n = 32)

P valuea

10 (33.3%)
14 (8.5)
6.3 (2.8)
4.9 (2.0)

14 (43.8%)
15.9 (7.9)
7.4 (1.9)
4.2 (1.6)

.78b
.59c
.063c
.11d

5 (17.2%)
9 (31.0%)
7.4 (3.75)
12 (40.0%)

4 (12.5%)
18 (56.3%)
12.0 (4.25)
15 (46.9%)

.65c
.32c
<.001c
.97b

Note. IQR = interquartile range; NCCN = National Comprehensive Cancer Network.
a
P value <.05 indicates statistical significance.
b
Chi-square.
c
t test.
d
Mann-Whitney U test.

Table 4. Safety Endpoints.

Respiratory rate <10 breaths per minute
Oxygen saturation <90%
Naloxone use during admission

Preimplementation group,
n (%) (n = 28)

Postimplementation group,
n (%) (n = 32)

P valuea

3 (10.7%)
3 (10.7%)
1 (3.4%)

1 (3.1%)
3 (9.4%)
0 (0.0%)

.24b
.87b
.29b

a

P value <.05 indicates statistical significance.
Z test.

b

Another consideration is the effect of the timing of
patient admissions with pain outcomes and use of the pain
scoring tool. It was found that fewer patients achieved analgesia if they were admitted between 1501-2300 compared
with those admitted between 0701-1500 and 2301-0700.
While many factors may contribute to this outcome, we also
predict that the pain scoring tool is being used less within
these hours as our pharmacy services shift to a higher
emphasis on operation functions overnight. While it was

found that there was not a statistically significant increase in
NCCN guideline-adherent pain regimens between the preimplementation and postimplementation groups, an interesting correlation in the rate of improvement with respect to
the primary endpoint was observed. Guideline-adherent
pain regimens increased 6.9% after the addition of the pain
scoring tool, and attainment of analgesia increased 10.5%,
suggesting guideline adherence may positively influence
analgesia attainment (Figure 3).
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