LAUSR

293 Background: Pain control is a challenging balance in the ambulatory oncology practice. Standard methods of pain reassessment resulted in poor pain control in the majority of patients given prescriptions for narcotics. We developed a proactive reassessment of pain using patient reported outcomes and a coach to assist in medication usage. The aim was to decrease the time to reassessment of pain to fewer than 5 days and achieve acceptable pain control in greater than 50% of patients receiving new narcotic prescriptions in an ambulatory oncology setting. Methods: Patients receiving a new narcotic prescription or a new dose were provided with a pain diary and an appointment with their pain coach at 48 hours. Using a standard pain scale 1-10, patients’ pain scores were recorded by the patient in their pain diary and communicated via nurse/patient phone contact at 48 hour intervals. Dosing intervention by the patient’s oncologist was made for unacceptable pain and reassessed at 48 hours. Uncontrolled pain at 96 hours was followed by in person appointment with the oncologist. Pain scores and days to reassessment were recorded using an Excel data collection tool for patients receiving new or dose adjusted narcotic prescriptions between August and December31, 2017. Results: There were 17 patients encounters where the patient received a new prescription or a dose change from August 1- Dec 31, 2017. Reassessment of pain was achieved in 100% of patients in fewer than 5 days. The average time was 2.6 days (range 2-4). Acceptable pain control (pain scores 0-3) at the time of reassessment was achieved in 53% of patients. Conclusions: Cancer related pain is an ongoing challenge in oncology practices. Barriers include lack of planned follow-up and patient education. The institution of a pain coach, pain diary and scheduled contact decreased the time to reassessment of pain and decreased pain scores during short interval reassessment periods achieving better pain control in 50% of patients during the evaluated period. Quality interventions in ambulatory settings are achievable though multiple patient interactions and record keeping require additional staffing resources to sustain this change.