Is It Painful to Manage Chronic Pain? A Cross-Sectional Study of Physicians In-Training in a University Program.

BACKGROUND: Prescribing opioids for chronic non-cancer pain (CNCP) is a challenge due to associated risks from abuse, addiction and adverse effects. We surveyed resident physicians on their knowledge, attitude and practices in opioid prescription practices in the ambulatory setting and conducted an educational module to address their knowledge gaps. METHODS: A phase 1 survey assessed knowledge, attitudes and practices of residents in the out-patient management of CNCP with opioids. Demographics, numbers of patients seen, those with concerns for risky behaviors, adverse effects and the reasons for concern were also recorded. In Phase 2, an educational module in the form of didactics and case based discussions addressed the perceived deficiencies noted from results of phase 1 survey. Pre and post module surveys assessed the effectiveness of the educational module. RESULTS: In the phase 1 study (45/49, 92% response rate, M:F = 30:15) 33.3% (15/45) were in Post-Graduate Year (PGY) 1, 35.6% (16/45) PGY2s and 31.1% (14/45) PGY3s; 80% (36/45) saw more than one patient with CNCP in the previous 3 months; 62.2% (28/45) had at least one patient with concerns for misuse and addiction; 77.8% (35/45) and 86.7% (39/45) reported a lack of training and consistent documentation respectively, and 82.2% (37/45) were uncomfortable to refill for other provider's patients. All (100%, 45/45) consulted the clinical pharmacist; 86.7% (39/45) believed that either focused education would be beneficial. In the phase 2 study (44/49, 89.7% response rate, M: F = 29: 15), the pre- and post-module responses showed that > 90% of the residents perceived improvement in knowledge and confidence in management of CNCP with opioids after the educational module. CONCLUSIONS: Internal medicine residents perceived deficits in their ability to manage CNCP. Following a focused educational training, residents' knowledge and confidence in prescription of opioids improved, demonstrating the need to include management of CNCP with opioids into their curriculum.

Transfer of care communication: improving communication during inter-facility patient transfer.

Patient care during inter-facility transfer depends not only on the expertise provided by the receiving facility, but also on timely and accurate patient information received from the transferring institution. Our prospective study quantified compliance with inter-facility transfer communication and revealed an opportunity for improvement. Introduction of a simple written template to enhance communication between providers improved the quality of transfer information.

A multidisciplinary quality improvement educational initiative to improve the rate of deep-vein thrombosis prophylaxis.

PURPOSE: To describe a quality improvement initiative to improve deep-vein thrombosis (DVT) prophylaxis rates among hospitalized medicine patients. METHODS: A standardized admission order-set with an embedded risk-assessment tool and DVT prophylaxis orders was developed. RESULTS: An audit 2 months after the intervention showed the use of optimal DVT prophylaxis was 91%, an increase from 75%. Chart review 1 year after the implementation of the order-set revealed that the increase in DVT prophylaxis was sustained at 95%. CONCLUSION: The use of formalized quality improvement methods to implement an intervention is effective in changing physician behaviour.