One striking opportunity for improvement is in opioid drug prescribing practices. The most glaring issue for many Breakthrough Series teams was the use of meperidine. One hospital calculated the morphine equivalent dosages for all of its repeated dose prescriptions. Half were for meperidine, the only opioid that is routinely contraindicated because of its short duration of action and because one of its metabolites is a central nervous system stimulant (often causing delirium and agitation). Although physicians' commitments to historical prescribing patterns are strongly held, a pharmaceutical committee embarked on a program of changes to prevent this misuse. Similar pharmacy-based and often automated approaches could nearly halt incorrect conversions from one delivery system or drug to the next (e.g., when changing from an IV to oral morphine).
|Key Recommendations for Managing Chronic Pain in Older People|
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].