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Clinical pharmacy and clinical trials (including case series)
Development of a practical guide to drug therapy of refractory pain in advanced palliative situation
  1. D. Denis,
  2. Y. Gauquelin,
  3. M. Dubasque,
  4. V. Malvezin,
  5. J.Y. Jomier
  1. 1Centre hospitalier de Pau, pharmacie, Pau, France
  2. 2Centre hospitalier de Pau, équipe mobile de soins palliatifs, Pau, France


Background Complex situations of medical management of refractory pain in patients in advanced or terminal phase of a serious and incurable disease and development of home care have led the French Agency for Sanitary Safety of Health Products to develop recommendations on how to use eight classes of drugs outside their Marketing Authorisation.

Purpose Our work is to provide a guide to regulate off-label use of these drugs often reserved for hospital use or restricted prescription and unknown by the non-hospital health professionals or non-specialist who often called for assistance.

Materials and methods A multidisciplinary working group (specialists in palliative care, pharmacists, paramedics) was established to develop practical guide for using these drugs. This booklet is a tool for the prescribing, dispensing and administration of these products. After validation by the Committee against Pain and the Committee of Drug, this guide will be disseminated to doctors and nurses at the Hospital of Pau, but also to non-hospital doctors, paramedics and pharmacists through the local network of palliative care and various continuing education sessions.

Results The guide was written on A4 size, foldable three. It includes a table summarising, for each class of medications, the following informations: context of use, methods of administration, specialties available (in hospital or city pharmacy), dosages, rules of prescription, adverse effects and monitoring. Various practical informations are associated with it. After approval by committees, the guide was tested by hospital professionals. Much appreciated by users because it provides quickly essential information (especially dosages, procedures for administering and monitoring), The authors decided to distribute it to non-hospital professionals during continuing medical education organised by the network.

Conclusions The authors hope this tool will provide assistance to every professional affected by palliative situations in hospital and at patient's home. The authors will conduct a satisfaction survey of the different users in order to make improvements if necessary.

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