Tool may improve pain management in nursing homes

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An experimental “Pain Medication Appropriateness Scale” (PMAS) appears to be a useful tool for assessing the suitability of prescribing practices in nursing homes and for testing whether interventions to improve prescribing behavior are effective, investigators report.

Improving pain management in nursing homes has become a priority for the Centers for Medicare and Medicaid Services and the Joint Commission for Accrediting Health Organizations, Dr. Evelyn Hutt and colleagues note in a report in the Journal of the American Geriatrics Society.

However, the process to improve pain management is not straightforward, and “a tool such as the PMAS would be useful in elucidating why nursing home residents have poorly controlled pain,” Hutt told Reuters Health. She explained that the PMAS combines nurses’ assessment of patients’ pain and a chart audit, from which a score is calculated.

Criteria in the PMAS include type of pain, such as persistent or breakthrough pain; pain severity; degree of relief obtained from medication; a constipation regimen for patients taking opioids; and exclusion of high-risk drugs, such as codeine-containing drugs.

Hutt’s group tested the PMAS among 1104 patients in 12 nursing homes. The mean total score was 64 percent of optimal, “which suggests that pain prescribing practices in nursing homes are generally poor,” the authors write.

Fewer than half of residents with predictable recurrent pain had scheduled pain medication and 23 percent were receiving at least one medication considered to be high risk.

The researchers also found that educating the nursing home staff can improve pain management practices.

SOURCE: Journal of the American Geriatrics Society February 2006. 

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