(1030) Naloxone utilization monitoring to improve institu-tional pain management practices

R. Hutchison, O. Gonzalez; Presbyterian Hospital Dallas, Dallas, TXThe objectives of this study are to evaluate the utility of automatednaloxone use reports and chart reviews to detect medication errors andadverse effects in pain management. Also, to determine the effective-ness of education as tool for process improvement in pain management,specifically opioid use, prevention of adverse effects, and minimizingmedication errors. It has been estimated that over one million U.S. hos-pitalized patients are injured by medical errors each year and approxi-mately 180,000 die as a result. National attention has focused on theoccurrence, clinical consequences, and costs of injuries in hospitals,which are estimated at $2 billion annually in the United States.. Untilrecently, little attention has been given to understanding causes ofthese errors, or developing methods to prevent them. This may be be-cause medical injuries seem to have few common causes, but also therewas a general lack of awareness of the problem. Chart review for nal-oxone use at an institution can provide direct and specific feedback onadverse drug reaction patterns. Review of this usage can be a useful toolto assess the need for education and process improvement. The costassociated with implementation of type of monitoring is minimal. Arecent survey by a member of the American Pain Society revealed thatonly 35% of surveyed institutions used chart review of naloxone use as atool to improve pain management. An 81% reduction in opioid relatedadverse effects and medication errors resulted after intensive educationand direct feedback to hospital staff. In conclusion, opioid related errorsand adverse effects can be significantly reduced by monitoring naloxoneutilization.

(1031) Interrater & interdevice reliability of physical therapist& client rating of low back pain with a visual analoguescale & a picture scale

R. Henderson, M. Primack; Rosalind Franklin University of Medicine and Sci-ence, North Chicago, ILThe purposes of this study were to assess congruence between 1) phys-ical therapist and client perception of low back pain and 2) Visual Ana-logue Scale (VAS) and Picture Scale (PS) pain ratings. Congruence ofpractitioner and client pain rating is essential in clinical decision making.Clinical use of these scales is widespread. However, there is limited re-search regarding their reliability in rehabilitation medicine. The sampleof convenience (n � 28) consisted of volunteer subjects (median age �40.5 years), from one outpatient orthopedic physical therapy practice,that were experiencing low back pain. A physical therapist and clientsimultaneously rated the client‘s pain with the VAS and PS. Each wasblinded to the other‘s rating. The VAS was standard (10 cm. line) and thePS consisted of eight (8) hierarchically arranged realistic facial expres-sions. Descriptive statistics were used to summarize demographic andpain rating data. The Spearman (rho) Rank Correlation was used todetermine the relationship between therapist and client pain ratings,and between VAS and PS scores. The Wilcoxon Signed Rank (�2�.05) wasused to determine if there were corresponding significant differences.There was high correlation between physical therapist and client usingthe VAS (rranks�.80) and the PS (rranks�.75), and between VAS and PSvalues for physical therapists (rranks�.93) and clients (rranks�.83. Therewas no statistically significant difference (p � .05) between physicaltherapist and client pain ratings using either scale. However, there wasa statistically significant difference between client VAS and PS ratings.Interrater reliability of the VAS and PS is high, suggesting that physicaltherapists can rely upon their judgement of client pain using either ofthese scales, in clinical decision making. However, interdevice reliabilityof these scales is questionable suggesting that the scales are interpreteddifferently and should not be used interchangeably.

(1032) Studies of patients with cancer, low back pain, andirritable bowel syndrome demonstrate that shortforms of the Multidimensional Affect and Pain Survey(MAPS) and other questionnaires must be tailored toeach patient group

N. Sonty, S. Chokhavatia, G. Griswold, H. Knotkova, W. Clark; Columbia Uni-versity, New York, NYResponses by 100 cancer outpatients to the 101-item MAPS were ana-lyzed using item analysis to obtain measures of inter-item consistencyand discriminability, as well as Cronbach‘s alpha. These data were thenused to select one item from each of the 30 101-MAPS clusters, thusensuring that the hierarchical structure of the 101-MAPS dendrogramwas preserved. In other, separate studies, two groups of experiencedmedical personnel (attending physicians, residents, and nurse practitio-ners) rated the relevance of each of the 101 MAPS items to the assess-ment of patients with (a) chronic low back pain (CLBP) and (b) irritablebowel syndrome (IBS). The 30 questions, one from each cluster, rated asmost relevant were selected for the shorter questionnaires. Of the 30items selected for the assessment of the patients with CLBP, there wasagreement with the cancer patients on 10 of 17 items (59%) in theSomatosensory Pain supercluster, 5 of 8 items (63%) in the EmotionalPain supercluster, and 1 of 5 items (20%) in the Well-being supercluster.Of the 30 items selected for the assessment of the patients with IBS,there was agreement with the cancer patients on 11 of 17 questions(65%) in the Somatosensory Pain supercluster, 1 of 8 items (12%) in theEmotional Pain supercluster, and 4 of 5 (80%) of the items in the Well-being supercluster. Comparison of questions selected for short forms forpatients with CLBP and IBS demonstrated agreement on 13 of 17 items(76%) in the Somatosensory Pain supercluster, 6 of 8 items (75%) in theEmotional Pain Supercluster and with none of the 5 items (0%) in theWell-being supercluster. Because different questionnaire items are im-portant to different groups of patients, short questionnaires must betailored to the specific patient population that is being assessed.

(1033) A new method for evaluating efficacy of low back paintherapy

D. Roberts, R. Hamill-Ruth, B. Parker, S. Maximous, B. Clark, K. Nelson; Univer-sity of Virginia Health System, Charlottesville, VAClinical diagnosis is vitally linked to the recording and analysis of phys-iological data. Advanced analysis techniques helpful in other fields,however, typically lag in being applied to the clinical setting. One suchtechnique is Fractal Analysis (FA), which extracts information in timeseries data that is unused by conventional methodology. FA takes ad-vantage of repeating, or self-similar, patterns found in time series dataover long periods. Individuals that are young and healthy have beenshown to have a higher self-similarity than those who are older or sick.FA has recently been applied to analyze stride interval data on Parkin-son‘s patients which found a lower self-similarity parameter (alpha)than their corresponding controls. Given this, our objective was to per-form a pilot study to determine the utility of FA applied to stride intervaldata in evaluating the change in a patient‘s low back pain before andafter therapeutic injection. Knowing that the low back is functionallycoupled with the legs, our hypothesis was that a change in LBP due totherapy will correspond with changes in gait. Continuous stride intervaldata were collected for over 200 steps using a Physical Activity Monitor.The first patient, a 30 year-old female, received a right diagnostic facetblock. The second patient, a 59 year-old female, received a selectivenerve root block. Verbal pain scores decreased after injection (Patient 1:pre�6, post�4; Patient 2 pre�5, post�2). In particular, the alpha in-creased from an average of 0.85 (Patient 1: alpha�0.86, Patient 2: al-pha�0.82) to an average of alpha � 0.98 post-block (patient 1: alpha �0.97, patient 2: alpha � 0.98); a value of alpha � 1.0 would be expectedin a normal control subject. Fractal analysis of stride interval may offer ahelpful quantitative measure of efficacy of injection therapy for lowback pain.

116 Abstracts