Assessing the Appropriateness of Pain Medication Prescribing Practices in Nursing Homes

doi:10.1111/j.1532-5415.2005.00582.x

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Wiley InterScience

Journal of the American Geriatrics Society

Volume 54 Issue 2, Pages 231 - 239

Published Online: 19 Dec 2005

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

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Assessing the Appropriateness of Pain Medication Prescribing Practices in Nursing Homes

Evelyn Hutt, MD ^* , Ginette A. Pepper, RN, PhD, FAAN ^§ , Carol Vojir, PhD ^† , Regina Fink, RN, PhD, FAAN, AOCN ^‡ , and Katherine R. Jones, RN, PhD, FAAN ^∥

From the Denver VA Medical Center and ^*Department of Medicine, ^†School of Nursing, and ^‡Health Sciences Center, University of Colorado, Denver, Colorado; ^§College of Nursing, University of Utah, Salt Lake City, Utah; and ^∥School of Nursing, Yale University, New Haven, Connecticut.

Address correspondence to Evelyn Hutt, MD, Director of Research in Long-term Care, Denver VA Medical Center—151, 1055 Clermont Street, Denver, CO 80220. E-mail: Evelyn.Hutt@uchsc.edu

This work was supported by Grant U18-HS11093 from the Agency for Healthcare Research and Quality to the School of Nursing, University of Colorado Health Sciences Center (Principal Investigator Katherine Jones).

KEYWORDS

pain management • nursing home • dementia • quality of care

ABSTRACT

OBJECTIVES: To test a tool for screening the quality of nursing home (NH) pain medication prescribing.

DESIGN: Validity and reliability of measurement tool developed for a pre/postintervention with untreated comparison group.

SETTING: Six treatment NHs and six comparison NHs in rural and urban Colorado.

PARTICIPANTS: NH staff, physicians, and repeated 20% random sample of each home's residents (N=2,031).

INTERVENTION: Nurse and physician education; NH internal pain team to champion better pain management using a pain vital sign, consultations, and rounds.

MEASUREMENTS: An expert panel reviewed the Pain Medication Appropriateness Scale (PMAS) for content validity. Research assistants interviewed NH residents, assessed them for pain using standardized instruments, and reviewed their medical records for prescriptions and use of pain and adjuvant medication. Construct validity was assessed by comparing the PMAS of residents in pain with the PMAS of those not in pain and comparing scores in homes in which the intervention was more effective with those in which it was less effective, using the Fisher exact and Student t tests. Interrater and test-retest reliability were measured.

RESULTS: The mean total PMAS was 64% of optimal. Fewer than half of residents with predictably recurrent pain were prescribed scheduled pain medication; 23% received at least one high-risk medication. PMAS scores were better for residents not in pain (68% vs 60%, P=.004) and in homes where nurses' knowledge of pain assessment and management improved or stayed the same during the intervention (69% vs 61%, P=.03).

CONCLUSION: The PMAS is useful for assessing pain medication prescribing in NHs and elucidates why so many residents have poorly controlled pain.

DIGITAL OBJECT IDENTIFIER (DOI)

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