Table 1 Quality indicators selected for the study
Code | Question | Criterion | Area |
|---|---|---|---|
Sructural indicators | |||
E1 | Do you have questionnaires on the perceived quality of care received, to be completed by patients treated in your clinic? | The team must assess patient and family opinion and satisfaction periodically (9,13,19) | Improvement of quality |
E2 | Do you have care protocols based on clinical practice recommendations for the treatment of cancer pain? | The team should have a series of care protocols (9,13,19) | Teamwork systems |
E3 | Do you have patient information documents about pain and the procedures available for its treatment? | The patient must always be able to offer informed consent to the recommended interventions (9,13,19) | Patient rights |
E4 | Do you have protocols for follow-up and referral from the Departments of Oncology, Radiotherapeutic Oncology, and Palliative Care to the Pain Unit? | The team must have a care coordination protocol with the departments attending the patient (9,13,19) | Coordination between levels and departments |
E5 | Do you participate with other departments in monographic multidisciplinary consultations on relevant chronic painful disorders? | The team must participate in the established interdisciplinary meetings (9,13,19) | Teamwork systems |
E6 | Do you code your patients according to ICD-9 code 338.3 acute or chronic cancer pain? | Patients with cancer patient are to be registered with ICD-9 code 338.3 | Registry and documentation systems |
E7 | Do you have a registry of patients treated in the unit? | It is advisable for the unit to have a patient registry (9) | Unit organisation and management |
Process indicators | |||
P1 | Does the initial case history include personal medical information? | A full case history is to be compiled on occasion of the first visit to the unit (9,13,19) | Registry and documentation systems |
P2 | Does the initial case history include information on previous drug therapy for pain? | ||
P3 | Does the initial case history include antecedents referred to pain? | ||
P4 | Were scales, questionnaires, or other tools used for diagnosis, follow-up, and prognosis at initial evaluation of cancer pain? | The team should use validated scales for diagnosis, follow-up, and prognosis (13,20) | Therapeutic objectives |
P5 | Does the initial case history include data on the full physical examination, including regional pain, neurological, and orthopaedic assessment? | A full case history is to be compiled on occasion of the first visit to the unit (9,13,19) | Registry and documentation systems |
P6 | Does the case history include patient pain intensity scoring based on validated scales? | The team should use validated scales for pain assessment (13) | Therapeutic objectives |
P7 | Does the initial case history include information referred to initial treatment planning? | A pharmacotherapeutic plan should be defined for the patient (9,13,19) | Registry and documentation systems |
P8 | Does the case history include the treatment administered for pain, the doses, and administration routes? | A full care report should be available for the patient (13,20) | Registry and documentation systems |
P9 | Does the case history include rescue treatment in case of breakthrough pain, the doses and frequency of administration? | ||
P10 | Is adherence to therapy recorded in the case history? | ||
P11 | Is treatment tolerance with the occurrence of any adverse drug effects recorded in the case history? | ||
P12 | Was a psychological evaluation of the patient made on the first visit to the unit? | A psychological evaluation of the patient should be made on the first visit to the unit (9,19) | Integral care |
P13 | Does the patient have an initial evaluation of his/her needs reflected in the case history? | An initial evaluation of the patient needs should be made on the first visit to the unit, with registry in the case history (13) | Evaluation of needs |