Pilot testing implementation of the pain management clinical practice guideline in nursing homes.
Barbara Resnick, Rachel McPherson, Elizabeth Galik
PMID 38183965WHAT IT FOUND
Pilot implementation of a pain guideline in nursing homes increased appropriate pain assessments and deprescribed opioids without increasing reported pain.
However, care plans remained largely generic, and fewer than half of residents received a pain diagnosis for the underlying cause.
Key findings
01The intervention significantly increased the use of observational pain assessments and the creation of pain care plans, though most plans remained generic rather than individualized.
02Opioid and non-opioid analgesic use decreased significantly during the study period, yet the percentage of residents with documented pain also decreased, suggesting deprescribing did not lead to unmanaged pain.
03Diagnosing the underlying cause of pain did not improve, remaining low at both baseline and follow-up, indicating a gap in moving from symptom management to root-cause assessment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was a small pilot with only 50 residents in two nursing homes in a single state, limiting generalizability. There was no control group, so changes cannot be definitively attributed to the intervention alone. Data relied entirely on electronic medical records, which may be incomplete or biased. The study did not measure pain objectively via external evaluators, relying instead on staff documentation. The six-month duration was too short to determine if deprescribing and assessment changes were sustained. Other pain-adjuvant medications like antidepressants or anticonvulsants were not tracked.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not conclude that the guideline implementation successfully improved pain diagnosis. While assessments and care plans increased, the rate of diagnosing the underlying cause of pain did not significantly improve, remaining at only 4% of residents at follow-up.