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Nursing Home Staff Must Be Proactive In Identifying When A Resident Is In Pain

Pain is prevalent among nursing home residents and can take a major toll on mood, sleep, and overall function.  Despite the severity of the consequences, pain is not often managed adequately for this vulnerable group. There are many limitations to pain assessment and treatment in nursing homes.  Long-term care staff of these facilities often have difficulty evaluating and treating pain in elderly patients.

Although there are evidence-based clinical guidelines in the nursing home to facilitate pain management for older adult patients, they are often insubstantial.  Moreover, studies of interventions to establish pain guidelines have not shown to be effective in improving patient outcomes.

Researchers recently found that “embedding guidelines into explicit protocols and algorithms” improved decision-making pertaining to pain management.  Previous research has shown that assessment and treatment algorithms can significantly enhance practice and patient outcomes.  In order to be most effective, the algorithms must be implemented in a systematic intervention that calls for effective strategies aimed to improve clinical practice. These implementation practices include “collaborative patient management, clinician education, enhanced roles for nurses, engagement of influential opinion leaders, audit and feedback, and academic detailing.”

A recent study sought to improve pain practices in nursing homes utilizing pain assessment and management algorithms through intensive training. Twenty-seven nursing homes located in the greater Puget Sound area participated.  These facilities varied in regards to size, quality, and management.  The outcomes of the patients were evaluated using nursing assistant (proxy) reports and self-reported resident pain severity. Outcomes were measured at the beginning of the study, after intervention or training completion, and again half a year later.

The study results showed that a set of algorithms paired with intensive methods to encourage implementation of evidence-based pain assessment and management practices had no stronger effect than basic education in decreasing pain among elderly nursing home patients. Both the control and intervention groups showed no substantial changes in pain intensity at the end of the study.  Various other studies have also shown similar findings, with no significant improvement in outcomes from changing nursing home pain practice.

Although it may be difficult to conduct pain assessments to evaluate an older adult patient’s condition, nursing home facility staff must be proactive and vigilant in identifying when a patient is in pain. The quality of life of a nursing home resident can drastically change due to pain. It is crucial that staff take the necessary steps to assess pain and implement appropriate and effective treatment.