Assessing the appropriateness of pain medication prescribing practices in nursing homes.
OBJECTIVE
To test a tool for screening the quality of nursing home (NH) pain medication prescribing.


METHODS
Validity and reliability of measurement tool developed for a pre/postintervention with untreated comparison group.


METHODS
Six treatment NHs and six comparison NHs in rural and urban Colorado.


METHODS
NH staff, physicians, and repeated 20% random sample of each home's residents (N = 2,031).


METHODS
Nurse and physician education; NH internal pain team to champion better pain management using a pain vital sign, consultations, and rounds.


METHODS
An expert panel reviewed the Pain Medication Appropriateness Scale (PMAS) for content validity. Research assistants interviewed NH residents, assessed them for pain using standardized instruments, and reviewed their medical records for prescriptions and use of pain and adjuvant medication. Construct validity was assessed by comparing the PMAS of residents in pain with the PMAS of those not in pain and comparing scores in homes in which the intervention was more effective with those in which it was less effective, using the Fisher exact and Student t tests. Interrater and test-retest reliability were measured.


RESULTS
The mean total PMAS was 64% of optimal. Fewer than half of residents with predictably recurrent pain were prescribed scheduled pain medication; 23% received at least one high-risk medication. PMAS scores were better for residents not in pain (68% vs 60%, P = .004) and in homes where nurses' knowledge of pain assessment and management improved or stayed the same during the intervention (69% vs 61%, P = .03).


CONCLUSIONS
The PMAS is useful for assessing pain medication prescribing in NHs and elucidates why so many residents have poorly controlled pain.
Hutt
Evelyn
E
Denver VA Medical Center, Denver, Colorado 80220, USA. Evelyn.Hutt@uchsc.edu
Pepper
Ginette A
GA
Vojir
Carol
C
Fink
Regina
R
Jones
Katherine R
KR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D003704:Dementia / Q000150:complications; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010146:Pain / Q000150:complications / Q000188:drug therapy*; D010147:Pain Measurement; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012424:Rural Population; D014481:United States; D014505:Urban Population
D000700:Analgesics