TIP OF THE WEEK
How one agency manages pain in the elderly at home
QUESTION: According to some estimates, 25% to 50% of elderly people living in the community are living with pain. If this is so, why are the elderly among the most undertreated for pain?
ANSWER: Research into this issue has uncovered several explanations. Because pain is a subjective experience, clinicians rely, in part, on patient reporting, yet many elderly patients are reluctant to report pain. Their reluctance may stem from the fear of additional testing or treatment, addiction issues, or concerns about adverse reactions to medications. Some patients are unwilling to acknowledge pain because they view it as a metaphor for serious disease or death. Further complicating matters, some clinicians mistakenly believe that sensitivity to pain decreases with aging. And finally, patients and clinicians alike may consider pain a "normal" part of daily life for older adults.
Because of the paucity of pain care protocols for elderly adults living in the community, one home health care agency took these steps to develop their own pain management program.
TAKING A MULTIDISCIPLINARY APPROACH
During a two-stage process, the agency selected a pain management action team made up of nurses, physical therapists, occupational therapists, social workers, and physicians. Team members then conducted an extensive literature review to educate themselves about the issue. Team members rotated to promote maximum staff input and prevent burnout.
SELECTING OR DEVELOPING APPROPRIATE ASSESSMENT TOOLS
Next, the team designed a one-page pain assessment sheet appropriate for their elderly clients. It incorporated elements of several standard pain assessment tools, including a numeric and a FACES pain rating scale, a body map for documenting pain location, and sections for documenting the intensity, quality, onset, and effectiveness of patient-initiated pain management measures. Nurses also designed a user-friendly pain management letter to serve as a care plan and to provide community primary health care providers with a written record of the interventions planned.
EDUCATING PATIENTS AND STAFF
The pain action team developed an education program for staff members consisting of guest speakers with expertise in various pain-related topics. The team also distributed articles on key pain management topics, including fallacies regarding pain in the elderly. Staff development sessions reinforced the need to address and manage pain routinely.
FOSTERING PATIENT PARTICIPATION
To enlist the cooperation of patients and their families, the action team developed the Pain Monitoring Record, which allows a nurse to assess the effectiveness of pain management interventions during home health care visits. At the end of the month, the entire team, including the patient, evaluates the effectiveness of pain management measures and decides on the next step to follow. Options for follow-up include another month of the pain management program, a revisit to the primary care provider, or referral to a pain clinic or specialist.
EVALUATING THE PAIN PROGRAM
Because levels of compliance varied and intervention occurred in patients' homes, they needed a consistent evaluation plan. They use the Outcome and Assessment Information Set (OASIS) mandated by the Centers for Medicare & Medicaid Services. Conducted at the first home health care visit and at specified intervals during care, OASIS tracks the patient's pain while evaluating the impact of the pain management program.
Source: Managing pain in elderly patients at home, Springhouse Corporation Aug 2001
RESOURCES TO IMPROVE PAIN
- General Pain Principals: Online Self-Study Module for 1hr nursing CEUs.
- Browse the Ohio KePRO Shopping Bag and order materials free of charge.
IN THE NEWS
HOME HEALTH PAY FOR PERFORMANCE DEMONSTRATION PROJECT
November 28, 2006 - - CMS - - The Centers for Medicare & Medicaid Services (CMS) announces plans for a Home Health Pay for Performance (P4P) Demonstration project. The demonstration project is being undertaken to "determine the impact of incentive payments to home health agencies (HHA) for improving the quality of care of Medicare beneficiaries."
A presentation discussing design principles and specifications including proposed quality and performance measures, performance monitoring methodology, scoring rules and incentive pools and payments is now available on the demonstration Web site. Learn more >>
IHI LAUNCHES 2-YEAR CAMPAIGN TO PROTECT 5 MILLION LIVES FROM HARM
December 2006 - - IHI - - The Institute for Healthcare Improvement (IHI) today announced, with the support of prominent leaders in American health care, a national campaign to dramatically reduce incidents of medical harm in U.S. hospitals. The 5 Million Lives Campaign will ask hospitals to improve more rapidly than before the care they provide in order to protect patients from five million incidents of medical harm over a 24-month period, ending December 9, 2008. This represents a continuation of the largest improvement effort undertaken in recent history by the health care industry. Learn more >>
SENIORS' HEALTH AND DAILY FUNCTION IMPROVES, STUDY FINDS
December 7, 2006 - - Kaiser Network - - The health and daily function of elderly U.S. residents has improved as the incidence of chronic disability has "dropped dramatically," according to a study released Tuesday by the National Institute on Aging, the Washington Times reports. The results were based on an analysis of the National Long-Term Care Survey, a periodic survey of about 20,000 Medicare beneficiaries. Read more >>
HOSPITAL PALLIATIVE CARE PROGRAMS CONTINUE RAPID GROWTH
December 7, 2006 - - EurekAlert - - Hospitals continue to implement palliative care programs at a rapid pace, according to a Center to Advance Palliative Care (CAPC) analysis of the latest data released in the 2006 American Hospital Association (AHA) Annual Survey of Hospitals. The CAPC analysis shows that 1,240 hospitals nationwide provide palliative care programs today. This is compared to 632 programs in 2000–a five-year increase of 96%. Read more >>
COMING ATTRACTIONS
KICK-OFF TO THE OHIO HOME HEALTH COMMUNITY OF PRACTICE
January 18, 2007, 9:00-10:00 a.m. or 3:00-4:00 p.m.
