Patient-controlled Analgesia: From 1 Different Sources
A technique whereby a patient can deliver an analgesic substance (see ANALGESICS) in amounts related to the extent of the PAIN that he or she is suffering. For example, to combat post-operative pain, some hospitals use devices which allow patients to give themselves small intravenous amounts of opiates when they are needed. Pain is more e?ectively controlled if it is not allowed to reach a high level, a situation which tends to happen when patients receive analgesics only on ward drug rounds or when they ask the nursing sta? for them.
Pain reduction or relief.... analgesia
A person in contact with the health system seeking attention for a health condition.... patient
In the United Kingdom, controlled drugs are those preparations referred to under the Misuse of Drugs Act 1971. The Act prohibits activities related to the manufacture, supply and possession of these drugs, and they are classi?ed into three groups which determine the penalties for o?ences involving their misuse. For example, class A includes COCAINE, DIAMORPHINE, MORPHINE, LSD (see LYSERGIC ACID DIETHYLAMIDE and PETHIDINE HYDROCHLORIDE. Class B includes AMPHETAMINES, BARBITURATES and CODEINE. Class C includes drugs related to amphetamines such as diethylpropion and chlorphentermine, meprobamate and most BENZODIAZEPINES and CANNABIS.
The Misuse of Drugs Regulations 1985 de?ne the classes of person authorised to supply and possess controlled drugs, and lay down the conditions under which these activities may be carried out. In the Regulations, drugs are divided into ?ve schedules specifying the requirements for supply, possession, prescribing and record-keeping. Schedule I contains drugs which are not used as medicines. Schedules II and III contain drugs which are subject to the prescription requirements of the Act (see below). They are distinguished in the British National Formulary (BNF) by the symbol CD and they include morphine, diamorphine (heroin), other opioid analgesics, barbiturates, amphetamines, cocaine and diethylpropion. Schedules IV and V contain drugs such as the benzodiazepines which are subject to minimal control. A full list of the drugs in each schedule can be found in the BNF.
Prescriptions for drugs in schedules II and III must be signed and dated by the prescriber, who must give his or her address. The prescription must be in the prescriber’s own handwriting and provide the name and address of the patient and the total quantity of the preparation in both words and ?gures. The pharmacist is not allowed to dispense a controlled drug unless all the information required by law is given on the prescription.
Until 1997 the Misuse of Drugs (Noti?cation and Supply of Addicts) Regulations 1973 governed the noti?cation of addicts. This was required in respect of the following commonly used drugs: cocaine, dextromoramide, diamorphine, dipipanone, hydrocodeine, hydromorphone, levorphanol, methadone, morphine, opium, oxycodone, pethidine, phenazocine and piritranide.
In 1997 the Misuse of Drugs (Supply to Addicts) Regulations 1997 revoked the 1973 requirement for noti?cation. Doctors are now expected to report (on a standard form) cases of drug misuse to their local Drug Misuse Database (DMD). Noti?cation by the doctor should be made when a patient ?rst presents with a drug problem or when he or she visits again after a gap of six months or more. All types of misuse should be reported: this includes opioids, benzodiazepines and central nervous system stimulants. The data in the DMD are anonymised, which means that doctors cannot check on possible multiple prescribing for drug addicts.
The 1997 Regulations restrict the prescribing of diamorphine (heroin), Diconal® (a morphine-based drug) or cocaine to medical practitioners holding a special licence issued by the Home Secretary.
Fuller details about the prescription of controlled drugs are in the British National Formulary, updated twice a year, and available on the Internet (see www.bnf.org).... controlled drugs
Any activities by a health professional involving direct interaction, treatment, administration of medications or other therapy or involvement with a patient.... direct patient care
Standardized tools to determine patient characteristics and abilities, what assistance they need and how they may be helped to improve or regain abilities. Patient assessment forms are completed using information gathered from medical records, interviews with the patient, other informants (e.g. family members) and direct observation.... patient assessment (resident)
See “care plan”.... patient care planning
See ETHICS.... patient choice
See ETHICS.... patient consent
An approach to care that consciously adopts a patient’s perspective. This perspective can be characterized around dimensions such as respect for patients’ values, preferences and expressed needs; coordination and integration of care; information, communication and education; physical comfort, emotional support and alleviation of fear and anxiety; involvement of family and friends; or transition and continuity.... patient-centred care
A study, generally undertaken by an individual health programme or health planning agency to determine the geographic distribution of the residences of the patients served by one or more health programmes. Such studies help define catchment and medical trade areas and are useful in locating and planning the development of new services.... patient-origin study
A method of comparing the results between two or more groups of patients intentionally subjected to di?erent methods of treatment – or sometimes of prevention. Those subjects entering the trial have to give their informed permission. They are allocated to their respective groups using random numbers, with one group (controls) receiving no active treatment, instead receiving either PLACEBO or a traditional treatment. Preferably, neither the subject nor the assessor should know which ‘regimen’ is allocated to which subject: this is known as a double-blind trial.... randomised controlled trial
the route that a patient takes through the health-care system, from first admission to a hospital or treatment centre to final discharge. This may consist of one or more *spells in particular hospitals and one or more *finished consultant episodes. For example, a patient admitted to a district general hospital, transferred to a tertiary hospital for a specialist procedure, and then transferred back to the district general hospital for recovery would experience one continuous patient pathway but three spells.... continuous patient pathway
At a personal level, the engagement of individuals in decisions about their health and about the diagnosis, treatment and after-care of their illness, injuries and other disorders. At a public level, the engagement of all members of the public in the planning, provision and performance of their health-care services. Traditionally, at both personal and public levels, the patient has generally been regarded as naturally subordinate to the politicians and managers who plan and run the health-care system(s), and to health professionals and medical institutions who provide personal health care. The public and patients are increasingly unwilling to accept this traditional model and are asserting themselves, for example through patient help groups, complaints, litigation and local political action with the aim of securing changes in how health care is organised and a much greater say in their own care.... patient empowerment
(COS) see superovulation.... controlled ovarian stimulation
see intervention study.... controlled trial
n. a patient who is admitted to a bed in a hospital ward and remains there for a period of time for treatment, examination, or observation. Compare out-patient.... in-patient
(NPSA) formerly, a special health authority that led and coordinated work to improve all aspects of patient safety in England. The NPSA comprised three divisions: the National Reporting and Learning Service, the National Research Ethics Service, and the National Clinical Assessment Service. It closed in 2012, with its key functions transferred to *NHS England. In 2016 the same functions were transferred from NHS England to the newly formed *NHS Improvement.... national patient safety agency
n. a patient who receives treatment at a hospital, either at a single attendance or at a series of attendances, but is not admitted to a bed in a hospital ward. Large hospitals have *clinics at which out-patients with various complaints can be given specialist treatment. Compare in-patient.... out-patient
(PALS) (in England) a confidential service provided by each NHS trust to support patients, their families, and carers by giving advice and information in response to questions and concerns about local NHS services. See also advocacy.... patient advice and liaison service
see PHQ-9.... patient health questionnaire
(PPACA) see Affordable Care Act 2010.... patient protection and affordable care act
see intervention study.... randomized controlled trial
a sedation technique, used particularly in dentistry, in which a mixture of *nitrous oxide and oxygen (‘gas and air’) is given. The patient remains conscious throughout; the technique is used to supplement local anaesthesia for nervous patients.... relative analgesia
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