BACKGROUND: The three-step analgesic ladder, recommended by the World Health Organization (WHO), serves as a guideline for managing cancer pain, progressing from non-opioids to weak opioids and strong opioids based on pain intensity. Despite its widespread use, challenges in standardizing its application persist, impacting medication safety and efficacy. This study aimed to implement the PDCA (Plan-Do-Check-Act) cycle in hospital inpatient pharmacies to improve the management and compliance of the three-step analgesic ladder for cancer pain patients. METHODS: A mixed-methods study design combining retrospective and prospective components was employed. Retrospective data on prescription compliance for three-step analgesics were collected from June 2021 to March 2022 (pre-implementation). The prospective randomized cohort study enrolled 160 advanced cancer patients from June 2022 to March 2023 (intervention and control groups). Interventions included paperless prescription management, enhanced patient education, and structured follow-ups. RESULTS: The prescription compliance rate improved significantly from 72.32% before implementation to 92.92% after implementation (P <
0.05). Satisfaction rates among medical staff with the management process increased from 81.09 to 94.22%, indicating enhanced efficiency and accuracy. Satisfaction rates reflected healthcare professionals' evaluation of improved prescription practices and reduced workload. Pain intensity, measured by the visual analog scale (VAS), decreased significantly in the intervention group compared to the control group (2.26 ± 0.78 vs. 3.07 ± 0.15
P <
0.01). CONCLUSIONS: The implementation of the PDCA cycle significantly improved compliance with the WHO three-step analgesic ladder, enhanced pain management outcomes, and increased satisfaction among healthcare professionals. Future studies should explore integrating patient-specific assessments to optimize individualized pain management strategies.