Safely managing pain in hospitalized older adults: Implementation of a geriatric acute pain management order set

Abstract

Introduction: Opioid pain medications carry serious risks when not used properly. Tools should be used to establish individualized, multimodal pain treatment plans that use opioids judiciously and effectively.This study aimed to explore outcomes of older adult patients who experience acute pain and determine if implementation of a Geriatric Acute Pain Management Order Set reduces opioid consumption during hospitalization, length of stay, unnecessary readmissions, and discharges to skilled nursing facilities. Materials and Methods: This was a retrospective chart review over 12 months at a Level I trauma center.Implementation of Geriatric Acute Pain Management Order Set on adults ≥70 years admitted to services diagnosed with long bone, rib, vertebral, or pelvic fracture. Exploratory analysis using the order set was compared to standard pain management practices. Results: Nonsignificant association was found between order set usage and average oral morphine equivalents (OMEs), consumption per day (P = 0.08), length of stay (P = 0.45), and number of days to readmission (P = 0.70). Hip/femur/pelvic fractures showed higher median OME/day (14.2 mg) compared to patients with humerus/scapula/clavicle fracture(s) (8.9 mg). Median OME/day was statistically different between types of service lines (P < 0.01), with orthopedics having the highest daily OME (30.4 mg). Most patients were discharged to skilled nursing facilities (n = 277) and homes (n = 114) with no demonstrated correlation between the amount of opioids consumed and discharge disposition. Conclusions: Order set integration into practice guides safe and effective care of older adults experiencing pain. Optimization of pain management modalities in the hospital serves to restore mobility and function, reduce patient harm, and improve quality of life. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, and Systems-based practice.