Pain Management Algorithms for Implementing Best Practices in Nursing Homes: Results of a Randomized Controlled Trial

Mary Ersek; Moni Blazej Neradilek; Keela Herr; Anita Jablonski; Nayak Polissar; Anna Du Pen

doi:10.1016/j.jamda.2016.01.001

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Journal article

Pain Management Algorithms for Implementing Best Practices in Nursing Homes: Results of a Randomized Controlled Trial

Mary Ersek, Moni Blazej Neradilek, Keela Herr, Anita Jablonski, Nayak Polissar and Anna Du Pen

Journal of the American Medical Directors Association, Vol.17(4), pp.348-356

04/01/2016

DOI: 10.1016/j.jamda.2016.01.001

PMCID: PMC4988793

PMID: 26897592

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Abstract

To enhance pain practices in nursing homes (NHs) using pain assessment and management algorithms and intense diffusion strategies. A cluster, randomized controlled trial. The intervention consisted of intensive training and support for the use of recommended pain assessment and management practices using algorithms (ALGs). Control facilities received pain education (EDU) only. Twenty-seven NHs in the greater Puget Sound area participated. Facilities were diverse in terms of size, quality, and ownership. Data were collected from 485 NH residents; 259 for the intervention and 226 for the control group. Resident outcomes were nursing assistant (proxy) report and self-reported resident pain intensity. Process outcomes were adherence to recommended pain practices. Outcomes were measured at baseline, completion of the intervention (ALG) or training (EDU), and again 6 months later. Among 8 comparisons of outcome measures between ALG and EDU (changes in 4 primary pain measures compared at 2 postintervention time points) there was only 1 statistically significant but small treatment difference in proxy- or self-reported pain intensity. Resident-reported worst pain decreased by an average of 0.8 points from baseline to 6 months among the EDU group and increased by 0.2 points among the ALG (P = .005), a clinically nonsignificant difference. There were no statistically significant differences in adherence to clinical guideline practice recommendations between ALG and EDU following the intervention. Future research needs to identify and test effective implementation methods for changing complex clinical practices in NHs, including those to reduce pain.

Nursing Homes

Humans

Male

Palliative Care

Evidence-Based Medicine

Process Assessment (Health Care)

Pain Measurement - methods

Sweden

Algorithms

Guideline Adherence

Diffusion of Innovation

Female

Aged

Pain Management - standards

Details

Title: Subtitle: Pain Management Algorithms for Implementing Best Practices in Nursing Homes: Results of a Randomized Controlled Trial
Creators: Mary Ersek - Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA; University of Pennsylvania School of Nursing, Philadelphia, PA. Electronic address: ersekm@nursing.upenn.edu
Moni Blazej Neradilek - The Mountain-Whisper-Light Statistics, Seattle, WA
Keela Herr - Adult and Gerontology Nursing, College of Nursing, University of Iowa, Iowa City, IA
Anita Jablonski - College of Nursing, Seattle University, Seattle, WA
Nayak Polissar - The Mountain-Whisper-Light Statistics, Seattle, WA
Anna Du Pen - Bainbridge Island, WA
Resource Type: Journal article
Publication Details: Journal of the American Medical Directors Association, Vol.17(4), pp.348-356
DOI: 10.1016/j.jamda.2016.01.001
PMID: 26897592
PMCID: PMC4988793
NLM abbreviation: J Am Med Dir Assoc
ISSN: 1525-8610
eISSN: 1538-9375
Publisher: United States
Grant note: R01 NR009100 / NINR NIH HHS R01NR009100 / NINR NIH HHS
Language: English
Date published: 04/01/2016
Academic Unit: Nursing Administration and Gen; Nursing
Record Identifier: 9984064154602771

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