Initiating and Sustaining a Standardized Pain Management Program in Long-Term Care Facilities

Keeney, Cynthia; Scharfenberger, Jennifer; O’Brien, James; Looney, Stephen W.; Pfeifer, Mark; Hermann, Carla

doi:10.1016/j.jamda.2008.02.004

Cited by 25 publications

(27 citation statements)

References 29 publications

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“…One recent survey found that symptom management is inadequate in long-term care facilities. 11 The recognition, assessment, and management of symptoms including pain are crucial components to ensure that patients are able to receive proper medical care. 12 According to the American Geriatrics Society and the American Medical Directors Association Clinical Practice Guidelines, symptom management can be improved through formalized symptom assessment.…”

mentioning

confidence: 99%

Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

Ornstein

Wajnberg

Kaye-Kauderer

et al. 2013

Journal of Palliative Medicine

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Background: Increasing numbers of patients are living with multiple, chronic medical conditions and functional impairments that leave them homebound. Home-based primary and palliative care (HBPC) programs provide access to health care services for this vulnerable population. Homebound patients have high symptom burden upon program enrollment. Yet little is known as to how individual symptoms are managed at home, especially over longer time periods. Objectives: The purpose of this study was to determine whether high symptom burden decreases following HBPC enrollment. Methods: All patients newly enrolled in an HBPC program who reported at least one symptom on the Edmonton Symptom Assessment Scale (ESAS) were eligible for telephone ESAS follow-up. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow-up care, interdisciplinary care management including social work, and urgent in-home care as necessary. Multivariate linear mixed models with repeated measures were used to assess the impact of HBPC on pain, depression, anxiety, tiredness, and loss of appetite among patients with moderate to severe symptom levels at baseline. Results: One hundred forty patients were followed. Patient pain, anxiety, depression, and tiredness significantly decreased following intervention with symptom reductions seen at 3 weeks and maintained at 12 weeks. ( p < 0.01) Loss of appetite trended toward an overall significant decrease and showed significant reductions at 12 week follow-up. Conclusion: In a chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. Future work should continue to explore symptom assessment and management over time for the chronically ill homebound.

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mentioning

confidence: 99%

Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

Ornstein

Wajnberg

Kaye-Kauderer

et al. 2013

Journal of Palliative Medicine

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“…A comprehensive plan for pain management should evaluate staffing patterns, staff education, and examine differences in pain policies and procedures to use pain management ultimately as a primary quality indicator in long-term care settings 86. Modeling theoretical constructs can serve as a valuable tool to determine the fit between clinical knowledge, the health care context, and individual needs.…”

Section: Resultsmentioning

confidence: 99%

Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care

Burfield¹,

Wan²,

Sole³

et al. 2012

CIA

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BackgroundThe purpose of this study was to determine the relationship between hypothesized pain behaviors in the elderly and a measurement model of pain derived from the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0 items.MethodsThis work included a longitudinal cohort recruited from Medicare-certified longterm care facilities across the United States. MDS data were collected from 52,996 residents (mean age 83.7 years). Structural equation modeling was used to build a measurement model of pain to test correlations between indicators and the fit of the model by cognitive status. The model evaluates the theoretical constructs of pain to improve how pain is assessed and detected within cognitive levels.ResultsUsing pain frequency and intensity as the only indicators of pain, the overall prevalence of pain was 31.2%; however, analysis by cognitive status showed that 47.7% of the intact group was in pain, while only 18.2% of the severely, 29.4% of the moderately, and 39.6% of the mildly cognitively impaired groups were experiencing pain. This finding supports previous research indicating that pain is potentially under-reported in severely cognitively impaired elderly nursing home residents. With adjustments to the measurement model, a revised format containing affective, behavioral, and inferred pain indicates a better fit of the data to include these domains, as a more complete measure of the pain construct.ConclusionPain has a significant effect on quality of life and long-term health outcomes in nursing home residents. Patients most at risk are those with mild to severe cognitive decline, or those unable to report pain verbally. Nursing homes are under great scrutiny to maintain standards of care and provide uniform high-quality care outcomes. Existing data from federally required resident surveys can serve as a valuable tool to identify indicators of pain and trends in care. Great responsibility lies in ensuring pain is included and monitored as a quality measure in long-term care, especially for residents unable to communicate their pain verbally.

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“…Pain should be treated aggressively as it decreases quality of life and functional status (84). Nursing home studies suggest that pain is regularly under-recognized (85)(86)(87). Pain outcomes are better when medications are given around-the-clock rather than as needed.…”

Section: Painmentioning

confidence: 99%

Clinical practice in nursing homes as a key for progress

Morley

2010

The Journal of nutrition, health and aging

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With the aging of the world's population there has become a major need for the development of nursing homes throughout the world. While some countries provide high quality care for the disabled elderly, in others this is not the case. Education of a medical director has been shown to improve the quality of the nursing home. Physicians need to have knowledge of how to implement continuous quality improvement and culture change. Key medical issues include moving to a restraint free environment, subsyndromal delirium, behavioral disturbances, weight loss, pain management, pressure ulcers, falls, hip fractures, polypharmacy, depression and frailty.

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Initiating and Sustaining a Standardized Pain Management Program in Long-Term Care Facilities

Cited by 25 publications

References 29 publications

Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

Behavioral cues to expand a pain model of the cognitively impaired elderly in long-term care

Clinical practice in nursing homes as a key for progress

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