Due to complex physical and psychological changes in aging, pain measurement and therapeutic treatment of older and geriatric patients present a special challenge. Nevertheless, even for this category of patients, good treatment results are achievable if age-related particulars and problems are consistently heeded and accounted for. That includes adverse sensory and cognitive effects as much as multimorbidity and the polypharmacy that is frequently related to it. An essential prerequisite for adequate pain therapeutic care in elderly patients is consistent pain measurement. While numerical and verbal scales have also proven their usefulness for patients in advanced age who are not cognitively impaired, instruments must be applied for older people with communicative and/or cognitive restrictions with which the observed behavior of those involved can be surveyed in a multidimensional way.

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seven-item questionnaire: prescription, monitoring, pump use, clarity of prescription, nurse skills and presence of a painreferent (specialised nurse). The information was collected in the care unit using PCA between June and September 2021. Results Seven department health executives were interviewed. Concerning the prescription: five departments use a computerised prescription, none include dilution information, and programming details are added by the prescriber because there is no prepared protocol. Two services use a paper prescription that is also the follow-up paper: they contain dilution information but not the background dose. Five services carry out the follow-up with a paper follow-up sheet, which differs according to the service, and two services use written computer transmissions. Concerning the other items: there is a lack of training sessions about the PCA pump use, only one service had a recent course by the company. Conclusion and relevanceThe assessment showed a disparity in the method of prescription and monitoring. It appears that essential data are missing, data which are necessary to have a complete prescription. It would be interesting to work on a computer protocol making it possible to simplify the prescription (basic dose, bolus, inter-dose, etc.), as well as to propose a single paper prescription for non-computerised services. A working group comprising representatives of the pharmacy department, prescribers from the care units concerned, health executives and pain-adviser nurses has been set up to work on this issue with the objective of improving patient care.

Clinical pharmacy services (CPS) have shown beneficial effects on several outcome measures in hospital patients, including the reduction of drug-related problems (DRP) and of therapy costs. Less is known about the impact of CPS in pediatric haemato-oncology, even though this patient population is highly susceptible to DRP. CPS were implemented in a tertiary care children’s hospital specialized in hemato-oncology and hematopoietic stem cell transplantation. The main outcome measures were type and number of DRP, type and number of pharmaceutical interventions (PI), their acceptance rate, and their clinical significance and economic benefit. During 6 months and 32 ward rounds, 275 DRP were identified and addressed by PI. The acceptance of PI was high (73.4%), and up to 80% of PI were rated as very significant or significant by independent external raters. The estimated therapy cost reductions were substantial, approaching at least EUR 54,600 for avoided follow-up costs. Conclusion: CPS improve medication safety in pediatric hemato-oncology and may reduce therapy costs.

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