| Description |
Of the 3.3 million Americans currently living in nursing homes, it is estimated that 45-80% suffer from significant chronic pain. Additionally, it is estimated that 70% of nursing home patients with dementia suffer chronic pain. Patients with dementia in nursing homes suffer disproportionately from uncontrolled pain. This is attributed to deficits in education and understanding of pain by providers and nursing staff and patient factors, such as the inability to adequately communicate their pain. There are several major contributors to the disparity of pain management. The first, and perhaps most problematic, is the lack of a standard assessment tool for those suffering from dementia. Because of cognitive deficits, patients with dementia are less likely to ask for pain medication and are more likely to receive inadequate dosing of analgesics. The second concern is the lack of scheduled pharmacological management of pain by healthcare professionals as well as improper follow-up by nurses and providers once analgesia has been administered. The lack of proper assessment and pharmacological management of pain is a problem because patients may suffer many consequences of chronic pain. Chronic pain results in depression, isolation, mood changes, reduced function, and decreased appetite. Additionally, in patients with dementia, agitation may be the primary symptom of pain resulting in treatment of the perceived agitation, not pain. Patients with dementia suffer a disproportionate percentage of pain because it is often unrecognized. This project was directed at educating nursing home providers and nursing staff associated with the Deseret Health Group in Salt Lake Valley on the utilization of a pain assessment tool designed for patients with dementia. It included education on proper pain assessment, prescriptive best practice, and improving communication with providers about patients' pain. Implementation of this project consisted of completing a review of the pain quality measure percentages in each of the four Salt Lake Valley nursing homes run by Deseret Health Group. This was to obtain the baseline percentage of patients suffering from pain in each of these nursing homes. Education was given to providers and nursing staff following the retrieval of quality measures. Three months after education was completed a follow-up review of the quality measures for each of these facilities was conducted. The percentage of patients suffering from pain was compared to the initial percentage of patients suffering from pain. In 3 of 4 facilities there was a decrease in the percentage of patients suffering from pain. When dementia patients have been identified as suffering from pain, scheduling around-the-clock medication is an appropriate intervention. Through the use of a more accurate tool for identifying pain in the demented population of nursing homes, the PAINAD pain scale, nurses and providers were able to identify patients suffering pain and were able to provide these patients with improved treatment. When dementia patients have been identified as suffering from pain, scheduling around-the-clock medication is an appropriate intervention. Closer monitoring of the effects and side effects of the medication led to fewer patients suffering from uncontrolled chronic pain. |
