Analgesic Use Patterns Among Patients With Dementia During Transitions From Hospitals to Skilled Nursing Facilities.
Andrea L Gilmore-Bykovskyi, Laura Block, Melissa Hovanes and 2 others
PMID 30703217WHAT IT FOUND
Pain medicines were changed often for dementia patients moving to skilled nursing: 23% of those given pain medicine in the last 48 hours had one stopped, and 38% of those with discharge pain prescriptions had one added that had not been given.
Check hand-offs.
Key findings
01Of 318 patients given analgesics in the last 48 hours, 73 (23%) had a potentially abrupt discontinuation on discharge.
02Of 297 patients with analgesics in discharge summary orders, 112 (38%) had a potentially abrupt addition that had not been administered in the last 48 hours.
03Among patients who received analgesics in the last 48 hours, potentially abrupt transition events were recorded in 67 of 254 hip fracture patients (26%) and 6 of 64 stroke patients (9%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study only looked at patients with dementia who had hip fracture or stroke and went to skilled nursing, so it may not apply to other dementia patients. It used records from 2003 to 2008 at two hospitals in one area, and most patients were white, so it may not reflect today's or other populations. It could not tell why medicines were stopped, added, or switched, or whether the changes were clinically appropriate. It did not measure pain, agitation, delirium, or other patient outcomes, so it cannot show that these patterns harmed patients. It only analyzed medicines used by at least 5% of patients for change events, so rarer pain medicines were not characterized the same way. Because it was retrospective, it could not capture chronic pain diagnoses or medication indications reliably.
Declared interests
The authors reported no conflicts of interest. The article is marked as NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not read these patterns as proof that patients were under-treated or harmed, or that a hand-off checklist works. The study counted record changes and did not measure pain or test an intervention.