CAPSTONE123

NP Adherence to Practice Protocol: Management of Persistent Pain in Older Adults

1; DNP Chair2, GNP, DNP, FAANP 1, 2Case Western Reserve University

Abstract

Even though persistent pain is highest among older adults, they have been insufficiently represented in clinical trials and studies on the management of persistent pain. Agism has had a negative impact on the adequate assessment and management of pain in older adults. Evidence has emerged indicating serious risk for cardiovascular, gastrointestinal and renal dysfunction with consistent use of NSAIDs and COX-2 analgesics. Other evidence supports the efficacious use of opioid analgesic in the treatment of moderate-to-severe persistent pain in older adults. Updated guidelines recommend more reliance on opioid analgesia.. This proposal aim is to implement an evidence-based practice protocol on the pharmacological management of persistent pain in older adults.

Background Information

An estimated 25% to 50% of older adults living in the community and up to 80% of those in nursing homes experience significant pain at least some of the time. Undertreated persistent pain in older adults has been linked to depression, anxiety, cognitive impairment, delirium, sleep disturbances, functional decline and increased healthcare utilization and cost. This project will implement a best practice so that each older adult in a clinic will be assessed and treated more effectively.

Persistent pain is a personal emotional and physical experience. Untreated or Inadequate Pain Management • Persistent pain is under-recognized and under-treated in older adults in many settings. • Those with dementia have a greater risk for inappropriate and inadequate pain treatment.

Pain Assessment with Older Adults • Many older adults under-report their pain so as not to be a burden. • Numeric Rating Scale (1-10) has been shown ineffective with older adults. •IPT has high validity and reliability.

Opioid Use with Older Adults • Guidelines support for persistent pain. • Prescribing practice of opioids in older adults is mixed.

Literature Review

1.GSA. (2009). Pharmacological management of persistent pain in older persons. Pain Medicine, 10(6), 1062-1083.

2. Flaherty, E. (2021). Pain assessment for older adults. ConsultGeri, 7. https://hign.org/consultgeri/try-this-series/pain- assessment-older-adults

References

Population (P): NP providers who make rounds in a 50- bed skilled nursing facility Intervention (I): Implementation of an evidenced-Based Protocol on the management of persistent pain in adults 50 years and older Comparison (C): Current practice of no protocol Outcomes (O): 20% improvement in self-report pain relief, 90% compliance rate of providers with protocol, 50% reduction on the use of NSAID with adults 50 years and older time (t): 60-days

PICOt Question

Implementation of a best practice protocol from the American Geriatrics Society on the pharmacological management of persistent pain in older adults. • Standardized pain assessment tool • Initial treatment – Acetaminophen • NSIDs and COX-2 used rarely • For pain scores at moderate or greater, opioid

therapy is considered.

Evidence-Based Intervention

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Outcome 1 – Iowa Pain Thermometer (IPT) self report on pain intensity related to a thermometer.

Outcome 2 – NP compliance rate with implementing protocol.

Outcome 3 – Filled NSAIDs per day compared to prior to implementation of protocol.

Outcome Measures