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Ameliorating Pain in Nursing Homes: A Collaborative Quality‐Improvement Project
Author(s) -
Baier Rosa R.,
Gifford David R.,
Patry Gail,
Banks Sara M.,
Rochon Therese,
DeSilva Debra,
Teno Joan M.
Publication year - 2004
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2004.52553.x
Subject(s) - medicine , minimum data set , medical prescription , physical therapy , quality management , intervention (counseling) , audit , pain management , nursing , pain assessment , coaching , nursing homes , management , management system , economics
Objectives: To evaluate a multifaceted intervention to improve pain‐management processes of care and outcomes in nursing homes. Design: Quasi‐experimental, pretest/posttest. Setting: Nursing homes in Rhode Island. Participants: Twenty‐one facilities. Intervention: This project used a multifaceted collaborative intervention involving audit and feedback of pain management, education, training, coaching using rapid‐cycle quality‐improvement techniques, and inter‐nursing home collaboration. Measurements: Pain‐management processes of care and outcomes, measured using chart review and the Minimum Data Set. Results: Of 21 facilities, 17 completed the project. Postintervention, nursing homes increased the use of appropriate pain assessments (3.9% vs 43.8%, P <.001), pain intensity scales (15.6% vs 73.9%, P <.001), and nonpharmacological treatments (40.5% vs 81.9%, P <.001). Prescriptions of World Health Organization Step II or Step III pain medications for residents with daily moderate or severe pain showed trends towards improvement (40.8% vs 50.6%, P =.057), but prescription of any pain medication (93.3% vs 94.6%, P =.710), change in pain medication (29.0% vs 30.1%, P =.386), and prescription of pain medications on a regularly scheduled basis (67.9% vs 69.5%, P= .370) did not. There was a 41.1% reduction in prevalence of pain (12.2% vs 7.2%, P= .032) between the pre‐ and postintervention time periods in the nursing homes that completed the project, whereas all the other facilities in Rhode Island (n=72) had only a 12.1% reduction (12.7% vs 11.2%, P= .286) during the same period. Conclusion: A multifaceted intervention improved pain‐management process and outcome measures in nursing homes.