Anne Zichterman, Pharm.D., had just been hired as the Pharmacy Clinical Specialist in Pain Management at Baptist Hospital in Nashville, Tennessee, when she decided to apply to the ASHP Foundation’s Pain Management Traineeship – and she describes it as her best educational experience to date. “It was a new step for my hospital to put a pharmacist in a position solely dedicated to pain management,” she says. “So it was a wonderful opportunity for me to work with Jennifer Strickland [at Lakeland Regional Medical Center in Orlando, Florida], a mentor who’s been doing this for a significant period of time.”
Strickland demonstrated how a pharmacist can work efficiently and effectively with other members of the health care team, was very interactive with trainees in discussing ideas, walked them through the steps involved in designing a new protocol for treating sickle cell anemia-related pain, and gave them the run of her own reference library.
Although Zichterman just completed the traineeship in June 2006, she has already made significant contributions at Baptist Hospital. “As part of improving patient outcomes and safety, the hospital wants to implement safe and effective pain management regimens,” she explains. “There were problems with patients overdosing on pain medications, not getting the correct ones, or just not getting relief from their pain.”
Zichterman began her mission with changes in patient-controlled analgesia (PCA) monitoring. Using much of the knowledge she’d gained from the Pain Management Traineeship, she created new requirements for PCA monitoring and order forms. She also instituted a consult service to better assess pain and put improved treatment regimens in place. Finally, new policies for pain management monitoring were designed and implemented.
Zichterman assisted with the development of a 35-page pain management guide to be used systemwide by all clinical staff. A Web-based program for physicians and nurses to improve pain management is also in the works.
Her biggest contributions in the area of pain management, however, involve the patients. During the traineeship, she observed patients who had been in motor vehicle accidents and were dealing with muscle spasms and neuropathic pain. Zichterman learned that commonly used analgesics such as opioids are not nearly as effective in these cases as are muscle relaxants or other adjuvant therapy. During her first week back at Baptist Hospital, she saw three patients with similar problems. “I was able to help them with the knowledge I’d gained regarding neuropathic pain, which is so often misunderstood and mistreated,” she explains. “Patients on a trauma service often have a very complex presentation of pain that involves not just muscle and bone pain but also neuropathic pain. When you can learn to treat that kind of pain, it is a real contribution.”
Although most hospitals do not have pharmacists who are pain management specialists, Zichterman believes that the traineeship experience would be valuable to any hospital or health-system pharmacist. “Pain is one of the most frequent symptoms that brings patients into the hospital,” she points out. “From a patient care perspective, so much good can be done by a pharmacist in any specialty with a solid background in pain management.”