Titler M, Herr K; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 39.
Department of Nursing Services & Patient Care, University of Iowa Hospitals and Clinics, 200 Hawkins Drive T100 GH, Iowa City, IA 52242; Tel: (319) 353-6995; Fax: (319) 353-8669; E-mail: marita-titler@uiowa.edu
RESEARCH OBJECTIVE: To describe the practice patterns of nurses and physicians in managing acute pain in older adults. These patterns are compared (1) to an evidence-based guideline for acute pain management in hospitalized elders, and (2) among age groups within the sample (e.g., young old and older old). STUDY DESIGN: Research-based quality indicators were selected from a newly formulated evidence-based guideline for acute pain management in hospitalized elders. Indicators were extracted from the medical records for the first 72 hours of care provided to the study population. Indicators include frequency of pain assessment/reassessment; parenteral morphine equivalent of opioids ordered/administered; profiles of analgesics (opioids and nonopioids) ordered/administered; and route of administration. Rates of these indicators were analyzed using descriptive statistics and compared, using inferential statistics, to evidence-based recommendations. POPULATION STUDIED: Patients 65 years or older hospitalized for a hip fracture in 12 acute care hospitals in the Midwest. PRINCIPAL FINDINGS: 16% of patients had their pain assessed every four hours. 13% of analgesic administrations were followed by reassessment of pain. 99% of medical records included orders for opioids, 98% included orders for nonopioids, and 97% included orders for acetaminophen; less than 14% of records included orders for NSAIDs. Sufficient amounts of opioids were ordered. Nurses administered relatively low doses of opioids, averaging 0.62 mg per hour over the 72-hour period. 35% of medical records included a physician order for around-the-clock administration of a nonopioid; 14% included an order for around-the-clock administration of an opioid; 28% included an order for patient controlled analgesia; 31% of all patient-controlled analgesia orders specified a basal rate. For 40% of the medical records, nurses administered on an around-the-clock basis opioids that had been ordered PRN. 70% of medical records included a physician order for meperidine and 47% included an order for propoxyphene; neither drug is recommended for use in older adults. 57% of medical records included at least one administration of meperidine, while 27% included at least one administration of propoxyphene. 78% of medical records included at least one physician order that specified administration of an analgesic via the intramuscular route. 52% of patients received at least one intramuscular administration of an analgesic. Nurses did not frequently use non-pharmacological interventions for pain other than repositioning. Pain management practices for older old patients were at greater variation from guideline recommendations than those for younger old patients. CONCLUSIONS: Many nurse and physician pain management practices for older adults do not follow practice recommendations that are based on research, especially when caring for older old patients. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Physicians and nurses have an opportunity to improve pain management practice patterns for older adults hospitalized in acute care settings. PRIMARY FUNDING SOURCE: AHRQ
Publication Types:
Keywords:
- Adult
- Aged
- Aged, 80 and over
- Analgesia
- Analgesia, Patient-Controlled
- Analgesics
- Analgesics, Non-Narcotic
- Dextropropoxyphene
- Hip Fractures
- Humans
- Meperidine
- Morphine
- Narcotics
- Nurses
- Pain
- Pain Clinics
- Pain Measurement
- nursing
- therapy
- hsrmtgs
Other ID:
UI: 102274254
From Meeting Abstracts