Case Report: Utility of Ketamine, Lidocaine, and Mexiletine as Nonopioid Adjuvants in Complex Cancer-Associated Pain.

Ketamine, lidocaine, and mexiletine are potential nonopioid adjuvant medications for the use of refractory cancer-related pain, particularly when opioids are demonstrating limited objective benefit. This is a case report of a single patient admitted to a large academic medical center in the United States. The patient is a 43-year-old woman with a history of Crohn's disease complicated by rectal squamous cell carcinoma and complex, progressive, and intractable pelvic and rectal pain. Over the course of hospitalization, her pain demonstrated limited opioid responsiveness despite marked fluctuations of her oral morphine equivalent doses. She also demonstrates variable responsiveness to ketamine. Lidocaine continuous infusion ultimately proves beneficial, and she is discharged after conversion to oral mexiletine. An overview of the hospital system's protocols for ketamine and lidocaine continuous infusions for pain and considerations for transitioning to mexiletine from lidocaine infusion are included.

Integration and assessment of the situation-background-assessment-recommendation framework into a pharmacotherapy skills laboratory for interprofessional communication and documentation.

BACKGROUND AND PURPOSE: The situation-background-assessment-recommendation (SBAR) framework is a commonly used method to structure verbal communication in the nursing and medicine disciplines and increases the effectiveness of interprofessional communication. The purpose of this manuscript is to describe how the SBAR framework is integrated into a pharmacotherapy skills laboratory for interprofessional communication and to report on student agreement of perceived realism, preparedness, and fairness of assessment relating to simulated SBAR activities. EDUCATIONAL ACTIVITY AND SETTING: Simulated, authentic interactions with healthcare providers were incorporated into a pharmacotherapy skills laboratory using the SBAR framework. Activities culminated with a performance-based assessment (PBA) exam which included verbal and written SBAR stations. Students completed a PBA exit survey reporting level of agreement with perceived realism, preparedness, and fairness of assessment related to the exam and answered open-ended questions reporting what they most and least liked. FINDINGS: After completion of the PBA exam, students reported they agreed or strongly agreed (78%) the PBA was realistic to practice. Students reported increased agreement they were prepared to verbally communicate recommendations compared to document recommendations in the written SBAR framework (64% and 52% agreed or strongly agreed, respectively). Thematic content analysis revealed students preferred to document in the SBAR format and felt it was more realistic than the subjective-objective-assessment-plan (SOAP) note format. DISCUSSION AND SUMMARY: The SBAR framework is relevant for pharmacist verbal communication and written documentation. Incorporation of the SBAR framework into a skills laboratory appears to prepare students for a PBA that was perceived as both realistic and fair.