Ameliorating pain in nursing homes: A collaborative quality-improvement project

OBJECTIVES: To evaluate a multifaceted intervention to improve pain-management processes of care and outcomes in nursing homes. DESIGN: Quasi-experimental, pretest/posttest. SETTING: Nursing homes in Rhode Island. PARTICIPANTS: Twenty-one facilities. INTERVENTION: This project used a multifaceted collaborative intervention involving audit and feedback of pain management, education, training, coaching using rapid-cycle quality-improvement techniques, and inter-nursing home collaboration. MEASUREMENTS: Pain-management processes of care and outcomes, measured using chart review and the Minimum Data Set. RESULTS: Of 21 facilities, 17 completed the project. Post-intervention, nursing homes increased the use of appropriate pain assessments (3.9% vs 43.8%, P < .001), pain intensity scales (15.6% vs 73.9%, P < .001), and nonpharmacological treatments (40.5% vs 81.9%, P < .001). Prescriptions of World Health Organization Step II or Step III pain medications for residents with daily moderate or severe pain showed trends towards improvement (40.8% vs 50.6%, P = .057), but prescription of any pain medication (93.3% vs 94.6%, P = .710), change in pain medication (29.0% vs 30.1 %, P = .386), and prescription of pain medications on a regularly scheduled basis (67.9% vs 69.5%, P = .370) did not. There was a 41.1% reduction in prevalence of pain (12.2% vs 7.2%, P = .032) between the pre- and postintervention time periods in the nursing homes that completed the project, whereas all the other facilities in Rhode Island (n = 72) had only a 12.1% reduction (12.7% vs 11.2%, P = .286) during the same period. CONCLUSION: A multifaceted intervention improved pain-management process and outcome measures in nursing homes.