Developing Quality Indicators for the Pharmacological Management of Chronic Non-Cancer Pain in Older Adult Inpatients: A RAND/UCLA Delphi Study.

Purpose: Chronic non-cancer pain (CNCP) is a disabling condition affecting many older adult inpatients. While first-line therapy for CNCP consists of non-pharmacological approaches, many older adults receive pharmacotherapy nevertheless, putting them at a high risk of medication-related problems. Quality indicators (QIs) for the pharmacological management of CNCP could help reduce this risk. This Delphi study aimed to establish the face validity and feasibility of a list of previously developed QIs for the pharmacological management of CNCP in older adult inpatients.

Patients and methods: We followed the RAND/UCLA Delphi study methodology to establish an expert consensus on a list of proposed QIs. Over two written rounds, nursing, pharmacy and medical experts rated the face validity and feasibility of the QIs identified in a previous systematic literature search. QI ratings that were uncertain or disagreed upon after the first round were discussed in three expert focus group discussions. The QIs discussed were rated again in round two, and the most relevant QI in each category was prioritised.

Results: Twenty-two experts agreed to participate in the study's deliberations. Nineteen experts (86%) returned their ratings in each written round, and 9 (41%) participated in the focus groups. They evaluated 61 proposed QIs, modified 11 of them and suggested 13 new ones. The final set consisted of 51 QIs, with the experts prioritising 23 different ones. The 51 QIs covered the categories of general pharmacotherapy and the appropriate use of opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, metamizole and co-analgesics.

Conclusion: Through consensus, we developed a first set of QIs for the pharmacological management of CNCP in older adult inpatients. This set will help standardise care, track and benchmark the quality of care, and be used as a trigger to prioritise patients for clinical or pharmacological interventions.