JAMDA
Volume 10, Issue 1 , Pages 67-73 , January 2009

Implementing a Pain Management Program in a Long-Term Care Facility Using a Quality Improvement Approach

  • Andres F. Leone, MD

      Affiliations

    • Corresponding Author InformationAddress correspondence to Andres F. Leone, MD, University of South Carolina, School of Medicine/Palmetto Health Richland Hospital, Department of Internal Medicine, Division of Geriatrics, 15 Medical Park, Suite 211, Columbia, SC 29203
  • ,
  • Francesco Standoli, MD
  • ,
  • Victor Hirth, MD

References 

  1. Hollenack K, Cranmer K, Zarowitz B, O'Shea T. The application of evidence-based principles of care in older persons (Issue 4): Pain management. J Am Med Dir Assoc. 2006;7:514–522
  2. Simonson CJ. Individuals with pain. In:  Youngkin EQ,  Sawin KJ,  Kissinger JF editor. Pharmacotherapeutics: A Primary Care Guide. Upper Saddle River, NJ: Pearson Prentice Hall; 2005;p. 215–224
  3. Burton AW. Outpatient management of breakthrough pain. Medscape Neurology & Neurosurgery. 2005;7:1–6Available at: www.medscape.com/viewarticle/506124_print. Accessed March 16, 2006
  4. Zagaria MA. Pain assessment in older adults: The cornerstone of controlling persistent pain. US Pharm. 2006;5:30–36
  5. Kane RL, Ouslander JG, Abrass IB. Essentials of Clinical Geriatrics. In: 4th ed.. New York: McGraw-Hill Inc; 1999;p. 269;468
  6. Won A, Lapane K, Gambassi G, et al. Correlates and management of nonmalignant pain in the nursing home (SAGE study group. Systematic assessment of geriatric drug use via epidemiology). J Am Geriatr Soc. 1999;47:936–942
  7. Gibson SJ, Helme RD. Age-related differences in pain perception and report. Clin Geriatr Med. 2001;17:433–456v–vi
  8. Bonica J. Definitions and taxonomy of pain. In: 2nd ed.. The Management of Pain. Vol. I:Philadelphia, PA: Lea & Febiger; 1990;p. 18–27
  9. Mersky H. Classification of chronic pain: Description of chronic pain syndromes and definition of pain terms. Pain. 1986;S1:
  10. Hopman-Rock M, Kraaimaat F, Bijlsma J. Quality of life in elderly subjects with pain in the hip or knee. Qual Life Res. 1997;6:67–76
  11. Zwakhalen S, Hamers J, Abu-Saad H, et al. Pain in elderly people with severe dementia: A systematic review of behavioral pain pain assessment tools. BMC Geriatr. 2006;6:3
  12. AGS clinical practice guidelines: The management of chronic pain in older persons. Geriatrics. 1998;53(Suppl 3):S6–S7
  13. Schnelle J. Total quality management and the medical director. Clin Geriatr Med. 1995;11:433–488
  14. Nolan T, Norman C, Provost L. The Quality Improvement Process – The Improvement Guide. Jossey Bass Publisher. 1996;
  15. Delgado-Guay M, Bruera E. Management of pain in the older person with cancer. Oncology (Williston Park). 2008;22:56–61
  16. Buhr GT, White HK. Quality improvement initiative for chronic pain assessment and management in a nursing home: A pilot study. J Am Med Dir Assoc. 2006;7:246–253
  17. Cipher D, Clifford P, Roper K. Behavioral manifestations of pain in the demented elderly. J Am Med Dir Assoc. 2006;7:355–365
  18. Weiner D, Peterson B, Keefe F. Chronic pain-associated behaviors in the nursing home: Resident versus caregiver perceptions. Pain. 1999;80:577–588
  19. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: Results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–2724
  20. Watkins PB, Kaplowitz N, Slattery J, et al. Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily (A randomized controlled trial). JAMA. 2006;296(1):87–93
  21. Gaston-Johansson F, Johansson F, Johansson N. Undertreatment of pain in the elderly: Causes and prevention. Ann Long-Term Care. 1999;7:190–196
  22. Huskisson EC. Measurement of pain. J Rheumatol. 1982;9:768–769
  23. Hicks C. The Faces Pain Scale–Revised: Toward a common metric in pediatric pain measurement. Pain. 2001;93:173–183
  24. Wong D, Baker C. Pain in children: Comparison of assessment scales. Pediatr Nurs. 1988;14:9–17
  25. Abbey J, Piller N, De Bellis A, et al. The Abbey pain scale: A 1-minute numerical indicator for people with end-stage dementia. Int J Palliat Nurs. 2004;10:6–13
  26. Kovach CR, Noonan PE, Griffie J, et al. The assessment of discomfort in dementia protocol. Pain Manag Nurs. 2002;3:16–27
  27. Nygaard HA, Jarland M. The Checklist of Nonverbal Pain Indicators (CNPI): Testing of reliability and validity in Norwegian nursing homes. Age Ageing. 2006;35:79–81
  28. Hølen JC, Saltvedt I, Fayers PM, et al. Doloplus-2, a valid tool for behavioural pain assessment?. BMC Geriatr. 2007;7:29
  29. Merkel SI, Voepel-Lewis T, Shayevitz JR, et al. The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293–297
  30. Snow AL, Weber JB, O'Malley KJ, et al. NOPPAIN: A nursing assistant-administered pain assessment instrument for use in dementia. Dement Geriatr Cogn Disord. 2004;17:240–246
  31. Fuchs-Lacelle S, Hadjistavropoulos T. Development and preliminary validation of the pain assessment checklist for seniors with limited ability to communicate (PACSLAC). Pain Manag Nurs. 2004;5:37–49
  32. Villanueva MR, Smith TL, Erickson JS, et al. Pain Assessment for the Dementing Elderly (PADE): Reliability and validity of a new measure. J Am Med Dir Assoc. 2003;4:1–8
  33. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc. 2003;4:9–15
  34. Cohen-Mansfield J. Pain Assessment in Noncommunicative Elderly persons—PAINE. Clin J Pain. 2006;22:569–575

 The authors have no conflicts of interest relating to this article.

PII: S1525-8610(08)00269-7

doi: 10.1016/j.jamda.2008.08.003

JAMDA
Volume 10, Issue 1 , Pages 67-73 , January 2009