Nursing Home Patients Benefit from Pain Management Model

A first-of-its-kind project to improve pain management practices at nursing homes in eastern Wisconsin is drawing national interest.

This unique model project by the Medical College of Wisconsin and the Froedtert Hospital Palliative Medicine Program is led by David E. Weissman, MD professor of medicine at the Medical College of Wisconsin and director of the Palliative Care Program.

"The failure to adequately assess and treat pain is a major public health issue, and pain management in nursing homes poses particular problems," said Dr. Weissman. According to Dr. Weissman, some of the challenges faced in nursing homes include remote and less frequent physician involvement, fear of state or federal regulations concerning the use of psychoactive medications, reliance on nursing assistants with little training in pain or symptom control to provide the bulk of direct patient contact, and a patient population with a high incidence of cognitive impairment and complex medical problems.

It has been well-documented that standard educational programs aimed at physicians and nurses have failed to change deeply held cultural and societal beliefs that inhibit good pain management, according to Dr. Weissman.

"In response to this problem," he said, "we have been working for the past decade to produce innovative educational programs designed to improve the practice of pain management through institutional change."

Key elements of this strategy are commitment to change, standardized assessment practices, a system of responsibility for poorly managed pain, educational programs for all staff and residents, and explicit standards of care for pain assessment and management.

As part of the model project, Dr. Weissman's team developed 14 objective indicators of excellent care to measure improvement in the quality of pain management in each nursing home. These indicators include use of different pain assessment tools for cognitively impaired and unimpaired patients, use of a standardized pain scale and a pain flow sheet document, specific pain protocols and policies, an interdisciplinary pain management program and a patient satisfaction survey program.

The team also looked for a quality improvement process, resident and family pain education, and new staff orientation for all nursing, rehabilitation and support staff.

Results from the first 87 facilities enrolled in the project in 1998 show that the number now employing more than half of the program's indicators has jumped from 14 percent to 80 percent.

With grant support from the Faye McBeath Foundation, the Helen Bader Foundation and the Eastern Area Health Education Center (AHEC), Dr. Weissman and his colleagues have focused on pain management improvement efforts in nursing homes since 1996.

For more information or to set up an appointment, please call 414-805-4605.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.