dis 2

Stephanie Knaggs posted

Results Section

As an orthopedic nurse, I decided to choose a topic relevant to my work and practice. My PICO (T) question asks, In hospitalized patients with dementia with hip fractures how does the use of opioid analgesics compared to non-opioid analgesics affect observed pain relief, safety, and adverse events during hospitalization? One article that I found regarding this topic was published in BMC Geriatrics in 2017 and discusses the topic of pain management for individuals with hip and pelvic fractures. While the abstract was helpful in determining the relevance of the article to my topic, I chose to explore the results section specifically to derive pertinent information that may have an impact on evidence based practice. For example, in this section we learn the facts--concrete data that was collected without interpretation. There were 13 studies that focused on patient data which were examined by two investigators; of which eight of those studies showed patients with dementia "received less drug-based pain management than people without cognitive impairment" and five studies that "did not identify under-treatment of pain for patients with dementia" (Moschinski et al., 2017, paras 20 & 21). Of the studies that concluded under treatment of pain in patients with dementia one study found that "advanced dementia patients in their study received one-third of the amount of morphine sulphate equivalents that the cognitively intact patients did" and "76% of the patients with dementia did not have a standing order for their analgesic agent for their entire hospitalization" (Moschinski et al., 2017, para. 20). This information is relevant to developing evidence based research because it begs the question of ethical treatment for cognitively impaired individuals. There are several factors that come into play such as taking into consideration opioid side effects and adverse affects, physician prescription of opioids vs. non opioids, and accurate assessment of pain in dementia patients. It will be interesting to see what the outcomes for dementia patients will be if we can have a standard of care in assessing and treating pain after sustaining falls and fractures. References

Moschinski, K., Kuske, S., Andrich, S., Stephan, A., Gnass, I., Sirsch, E., & Icks, A. (2017). Drug-based pain management for people with dementia after hip or pelvic fractures: a systematic review. BMC Geriatrics, 17, 1–15.  https://doi-org.ezproxy.snhu.edu/10.1186/s12877-017-0446-z

LINK TO ARTICLE

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310008/