title: Specific Physician Orders Improve Pain Detection and Pain Reports in Nursing Home Residents: Preliminary Data.
abstract: Despite evidence that many nursing home residents' pain is poorly managed, reasons for this poor management remain unanswered. The aim of this study was to determine if specific order sets related to pain assessment would improve pain management in nursing home (NH) residents. Outcomes included observed nurse pain assessment queries and resident reports of pain. The pretest/post-test study was performed in a 240-bed for-profit nursing home in the mid-southern region of the United States and participants were 43 nursing home residents capable of self-consent. Medical chart abstraction was performed during a 2-week (14-day) period before the implementation of specific order sets for pain assessment (intervention) and a 2-week (14-day) period after the intervention. Trained research assistants observed medication administration passes and performed participant interviews after each medication pass. One month after intervention implementation, 1 additional day of observations was conducted to determine data reliability. Nurses were observed to ask residents about pain more frequently, and nurses continued to ask about pain at higher rates 1 month after the intervention was discontinued. The proportion of residents who reported pain also significantly increased in response to increased nurse queries (e.g., "Do you have any pain right now?"), which underscores the importance of nurses directly asking residents about pain. Notably 70% of this long-stay NH population only told the nurses about their pain symptoms when asked directly. Findings uncover that using specific pain order sets seems to improve the detection of pain, which should be a routine part of nursing assessment.
authors.affiliation: Vanderbilt University School of Nursing, Nashville, Tennessee. Electronic address: todd.b.monroe@vanderbilt.edu.
authors.forename: Todd B
authors.initials: TB
authors.lastname: Monroe
authors.affiliation: Palliative Medicine Program, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sumathi
authors.initials: S
authors.lastname: Misra
authors.affiliation: Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Ralf C
authors.initials: RC
authors.lastname: Habermann
authors.affiliation: Vanderbilt University Schools of Medicine and Nursing, Nashville, Tennessee.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.affiliation: Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Bruehl
authors.affiliation: Department of Radiology, Vanderbilt University Medical Center, Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Cowan
authors.affiliation: Vanderbilt University School of Medicine, Vanderbilt Center for Cognitive Medicine, Vanderbilt University Medical Center, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (TVHS-GRECC), Nashville, Tennessee.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Newhouse
authors.affiliation: Vanderbilt University Department of Medicine, Center for Quality Aging and the Division of Geriatrics and the Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Simmons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D065186:Interrupted Time Series Analysis; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009726:Nurses; D009730:Nursing Assessment; D009735:Nursing Homes; D009743:Nursing, Practical; D010146:Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000451:nursing; D059408:Pain Management / Q000379:methods* / Q000451:nursing; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D014481:United States
chemical_list: D000700:Analgesics