Inappropriate Fentanyl Prescribing Among Nursing Home Residents in the United States.
Kevin M Fain, Carlos Castillo-Salgado, David D Dore and 3 others
PMID 27720662WHAT IT FOUND
Only 8.2% of nursing home residents who started fentanyl patches in 2008 had persistent pain, and 36.3% had no recent opioid use.
Older and more cognitively impaired residents were most likely to receive this inappropriate start.
Key findings
01Only 8.2% of nursing home residents starting transdermal fentanyl had persistent pain, and 36.3% had no opioid prescription ending within 2 months before starting.
0245.8% of residents aged 95 or older and 46.9% of residents with the most cognitive impairment had no opioid prescription in the prior 2 months, compared with 29.7% of residents aged 65 to 75 and 28.2% of cognitively intact residents.
03After adjustment, older age, greater cognitive impairment, Asian race/ethnicity, and higher socioeconomic status were associated with starting fentanyl while opioid-naïve.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The data are from 2008, so prescribing practice and pain assessment may have changed. Pain status came from MDS assessments, which may contain inaccuracies or biases. There was an average 33-day time lag between the last MDS measurement and fentanyl initiation. The analysis excluded residents with cancer, hospice care, Alzheimer disease, or the most severe cognitive impairment; these residents were 42.3% of those meeting initial inclusion criteria. The study did not assess whether residents with prior opioid use were opioid-tolerant. 561 of 18,800 residents were excluded for missing covariate data.
Declared interests
The authors declared no conflicts of interest. One author, GCA, is chair of an FDA advisory committee and has paid consulting relationships with PainNavigator and IMS Health.
The easy way to misread this
Do not conclude that fentanyl patches should be avoided in nursing homes. The study reports prescribing patterns, not pain relief or harms, and it excluded residents with cancer, hospice care, or the most severe cognitive impairment, who may have legitimate pain needs.