A Drug Use Evaluation of Selected Opioid and Nonopioid Analgesics in the Nursing Facility Setting

Cramer, Gena W.; Galer, Bradley S.; Mendelson, Marilyn A.; Thompson, G. G.

doi:10.1111/j.1532-5415.2000.tb04697.x

Cited by 72 publications

(53 citation statements)

References 31 publications

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“…However, there was no documentation of intensity in more than half of the charts, suggesting that even basic pain assessment is not consistently done. This finding reflects previous research and emphasizes the need for further investigation of the reasons for failure to adequately assess persistent pain in nursing home residents (Cramer, Galer, Mendelson, & Thompson, 2000). Lack of adherence to current best practice guidelines is problematic because when pain assessment is inadequate, the pain management plan will also be flawed.…”

Section: Discussionsupporting

confidence: 60%

Nursing Home Staff Adherence to Evidence-Based Pain Management Practices

Jablonski¹,

Ersek²

2009

J Gerontol Nurs

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The purpose of this study was to determine the extent to which nursing home staff adhere to current evidence-based guidelines to assess and manage persistent pain experienced by elderly residents. A retrospective audit was conducted of the medical records of 291 residents of 14 long-term care facilities in western Washington State. Data revealed a gap between actual practice and current best practice. Assessment of persistent pain was limited primarily to intensity and location. Although prescribing practices were more in line with evidence-based guidelines, a significant number of residents did not obtain adequate pain relief. Nonpharmacological pain management methods were rarely implemented. Nursing home staff and administrators must critically examine both system and individual staff reasons for failure to comply with best pain management practices. Research is needed to determine factors that contribute to less-than-optimal adherence to evidence-based guidelines for pain management, as well as the best methods for implementing practice change.The quality of care provided in U.S. nursing homes has long been a concern of policy makers, health care providers, and consumers. Following a study conducted in 1986, the Institute of Medicine (IOM) concluded that care provided in nursing homes was often seriously inadequate. These findings provided the impetus for enactment of the Omnibus Budget Reconciliation Act of 1987, which established higher standards of care for nursing homes receiving Medicare and Medicaid funding. Although the quality of care in nursing homes improved after this legislation went into effect, it is well known that care remains less than optimal in many instances (Weiner, Freiman, & Brown, 2007). The prevalence of pressure ulcers, malnutrition, and incontinence remains at unacceptable levels (IOM, 2001;Weiner et al., 2007). Of particular concern is the high number of nursing home residents who experience pain (AGS Panel on Persistent Pain in Older Persons [AGS Panel], 2002;Gibson, 2007;Zanocchi et al., 2007).Research indicates that as many as 83% of nursing home residents experience pain that often goes unrecognized or inappropriately treated (AGS Panel, 2002;Teno, Kabumoto, Wetle, Roy, & Mor, 2004;Zanocchi et al., 2007). This is significant in that the presence of persistent pain adversely affects mood, sleep quality, functional ability, and quality of life (AGS Panel, 2002;Leong & Nuo, 2007). From a systems perspective, the high prevalence of pain is a Address correspondence to Anita Jablonski, PhD, RN, Assistant Professor, Seattle University College of Nursing, 901 12th Avenue, PO Box 222000, Seattle, WA 98122-1090; jablonsk@seattleu.edu.. The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. 2003). The guidelines synthesize current best practice through integration of scientific evidence, clinical experience, and expert opinion. These resources can potentially increase the effe...

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Section: Discussionsupporting

confidence: 60%

Nursing Home Staff Adherence to Evidence-Based Pain Management Practices

Jablonski¹,

Ersek²

2009

J Gerontol Nurs

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“…Pain is a common, often underreported problem in LTC homes which is concerning to families [45, 49, 77–83]. Families have lower satisfaction when they perceive that their loved one's pain is not being adequately managed [82].…”

Section: Resultsmentioning

confidence: 99%

Measuring Family Members’ Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire

Nadin

Miandad

Kelley

et al. 2017

BioMed Research International

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Rationale Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. Methods and Results Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. Phase 2 The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. Phase 3 The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88–.94) indicated internal consistency. Conclusion This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.

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“…Although dementia is not specifically associated with pain, chronic comorbid conditions such as arthritis, fractures, and other musculoskeletal conditions can cause chronic pain. 23 On the basis of the bivariate analyses, reports of pain were significantly more likely among those who also experienced trauma/fractures, aspiration, circulatory problems, including PVD, hematology/oncology problems, musculoskeletal disorders, and pressure ulcers. In addition to specific conditions associated with reports of pain, a greater total number of health problems was associated with having pain reports.…”

Section: Discussionmentioning

confidence: 98%

Health Problems and Correlates of Pain in Nursing Home Residents With Advanced Dementia

Black¹,

Finucane²,

Baker

et al. 2006

Alzheimer Disease &Amp; Associated Disorders

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This study describes the health problems and comorbid illnesses of nursing home (NH) residents with advanced dementia (n=123) and identifies correlates of staff-identified pain. Study participants were residents of 3 NHs in Maryland, their surrogate decision makers and their physicians. Residents' cognitive function was assessed at study enrollment, and their medical records were reviewed to identify all health problems/illnesses and use of pain medications during the 6 months before their enrollment. The most prevalent health problems were skin problems (95%), nutrition/hydration problems (85%), psychiatric/behavioral problems (85%), gastrointestinal problems (81%), and infections (80%). Sixty-three percent of residents had recognized pain, and 95% of those residents received pain medications. In a multivariate regression analysis, staff-identified pain was associated with aspiration (P=0.008), peripheral vascular disease (P=0.021), musculoskeletal disorders (P=0.032), higher cognitive function (P=0.013), and use of pain medications, including non-opiates (P=0.004) and the combination of opiates and non-opiates (P=0.001). NH residents with advanced dementia experience a complex mixture of multiple chronic and acute comorbidities. These results suggest the need for clinicians in long-term care facilities to be vigilant in assessing and treating pain, particularly as cognitive function declines in those with advanced dementia.

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A Drug Use Evaluation of Selected Opioid and Nonopioid Analgesics in the Nursing Facility Setting

Cited by 72 publications

References 31 publications

Nursing Home Staff Adherence to Evidence-Based Pain Management Practices

Nursing Home Staff Adherence to Evidence-Based Pain Management Practices

Measuring Family Members’ Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire

Health Problems and Correlates of Pain in Nursing Home Residents With Advanced Dementia

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