Ameliorating pain in nursing homes: a collaborative quality-improvement project

J Am Geriatr Soc. 2004 Dec;52(12):1988-95. doi: 10.1111/j.1532-5415.2004.52553.x.


Objectives: To evaluate a multifaceted intervention to improve pain-management processes of care and outcomes in nursing homes.

Design: Quasi-experimental, pretest/posttest.

Setting: Nursing homes in Rhode Island.

Participants: Twenty-one facilities.

Intervention: This project used a multifaceted collaborative intervention involving audit and feedback of pain management, education, training, coaching using rapid-cycle quality-improvement techniques, and inter-nursing home collaboration.

Measurements: Pain-management processes of care and outcomes, measured using chart review and the Minimum Data Set.

Results: Of 21 facilities, 17 completed the project. Postintervention, nursing homes increased the use of appropriate pain assessments (3.9% vs 43.8%, P<.001), pain intensity scales (15.6% vs 73.9%, P<.001), and nonpharmacological treatments (40.5% vs 81.9%, P<.001). Prescriptions of World Health Organization Step II or Step III pain medications for residents with daily moderate or severe pain showed trends towards improvement (40.8% vs 50.6%, P=.057), but prescription of any pain medication (93.3% vs 94.6%, P=.710), change in pain medication (29.0% vs 30.1%, P=.386), and prescription of pain medications on a regularly scheduled basis (67.9% vs 69.5%, P=.370) did not. There was a 41.1% reduction in prevalence of pain (12.2% vs 7.2%, P=.032) between the pre- and postintervention time periods in the nursing homes that completed the project, whereas all the other facilities in Rhode Island (n=72) had only a 12.1% reduction (12.7% vs 11.2%, P=.286) during the same period.

Conclusion: A multifaceted intervention improved pain-management process and outcome measures in nursing homes.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Homes for the Aged / standards*
  • Humans
  • Male
  • Nursing Homes / standards*
  • Outcome and Process Assessment, Health Care / methods*
  • Pain / prevention & control*
  • Quality Assurance, Health Care / methods*
  • Rhode Island