Continuous Ambulatory Delivery Device Use for Patients Managed by an Inpatient Palliative Care Team

Madison Peters; Dr Justin Kutzko; Kalli Stilos

doi:10.1016/j.pmn.2024.02.014

Continuous Ambulatory Delivery Device Use for Patients Managed by an Inpatient Palliative Care Team

Pain Manag Nurs. 2024 Apr 13:S1524-9042(24)00023-7. doi: 10.1016/j.pmn.2024.02.014. Online ahead of print.

Authors

Madison Peters¹, Dr Justin Kutzko², Kalli Stilos³

Affiliations

¹ Advanced Practice Nurse, Division of Palliative Care Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
² Palliative Care Physician, Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, Brampton, Ontario, Canada; Senior Lecturer, University of Queensland, Brisbane, Australia.
³ Advanced Practice Nurse, Division of Palliative Care Sunnybrook Health Sciences Centre, Adjunct Clinical Faculty for Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. Electronic address: Kalli.Stilos@sunnybrook.ca.

PMID: 38616457
DOI: 10.1016/j.pmn.2024.02.014

Abstract

Background: The use of Patient Controlled Analgesia (PCA) via a Continuous Ambulatory Delivery Device (CADD) is a common and effective means of pain and symptom management for hospitalized patients with a malignancy. Studies exploring the indications for starting such a device for hospitalized inpatients referred to inpatient palliative care teams are limited.

Aim: This retrospective chart review aims to explore indications, timing of initiation, and barriers to the use of a CADD.

Methods: Over a six month period, during daily inpatient palliative care consult team rounds, patients who required a CADD were enrolled in this study. Sixty-one adult patients were identified who required a pump for symptom control. The team's database sheets were used to capture patient demographics.

Results: The main reasons for initiating a Continuous Ambulatory Delivery Device in the above setting included: lack of efficacy of oral opioids and to increase patient autonomy of their pain management. Approximately 20% of patients required transfer to another unit that could accommodate the CADD. The median length of stay for these patients was 13 days, with a median length of half a day for a pump to be started.

Conclusions: This initial study provides the Palliative Care Consult Team with information on the indications for the use of a CADD. The lack of universal access to a CADD in various areas of our hospital due to differences in departmental protocols may compromise good symptom management and patient safety. These results strengthen the argument that the existing hospital policy requires revamping to improve CADD access. A CADD has been shown to provide hospitalized patients, with a malignancy, with timely access to effective symptom management, and in turn, reducing their length of stay in hospital. These findings will help inform this organization's CADD policy and support the need to broaden access to this device.