Improving cancer pain management through a system wide commitment.

Despite the well documented need for better cancer pain management there is little evidence that conventional educational approaches have improved clinical practice. This article discusses strategies to improve cancer pain management, focusing particular attention to institutional approaches that contain quality assurance (QA) and quality improvement (QI) efforts. An innovative pain management project is described that includes an in-depth evaluation of system and provider strengths and weaknesses; a system-wide commitment to cancer pain management; patient/family, nurse, pharmacist, and physician collaborative teams; use of a Washington State law allowing pharmacist prescriptive authority of narcotics and other drugs within a prescribed treatment protocol; and QA and QI efforts to improve and document performance. The authors strongly believe that the development of collaborative programs that integrate the power of the institutional process with clinical care will produce the greatest improvement in patient care not only for cancer pain, but also for other difficult domains of end-of-life.