Clinical audit to evaluate the palliative care and pain relief practices in a tertiary care hospital
Journal Title: Medpulse International Journal of Anesthesiology - Year 2019, Vol 9, Issue 2
Abstract
Background: Malignancy is one of the life limiting illnesses. Palliative care includes relief of physical as well as emotional, spiritual and social pain. Assessment and management of symptoms is likely to ensure follow up, and compliance with treatment. This is a retrospective audit, conducted on patient records dealing with patients attending the palliative care and pain relief clinic in a tertiary care hospital. Methods: The records of 206 patients, who attended the pain clinic were scrutinised. The clinical diagnosis, staging of malignancy, and the treatment received were tabulated. The ECOG scale and Edmonton Symptom Assessment Scale (ESAS) were used to record the symptoms at first visit, and the best score during subsequent visits. Number of follow up visits were noted. The treatment administered, and whether it was according to the WHO step ladder, was observed. Results: 51.5% of patients were in stage IV at the time of referral to pain clinic. Out of total 206 patients, 122 patients had given the response for follow up after first visit. Therefore, the paired analysis was done in 122 patients. There was a highly significant improvement in all the symptoms, except for dyspnoea, and nausea. Relief of pain was achieved with paracetamol, followed by tablet Morphine in 70% of patients.85% of patients were treated according to the WHO guidelines. 65% of patients adhered to prescription. Conclusion: The audit revealed that compliance with WHO protocol resulted in good symptom control. 84 patients were lost to follow up. Addressing ‘total pain’ in the first visit could possibly lead to a better follow up rate.
Authors and Affiliations
Kannan Radhika, Uma R
Keywords
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