Monash researchers highlight successful interventions to improve painkiller use and appropriateness in residential aged care facilities

27 October 2021

An international study led by Monash University’s Centre for Medicine Use and Safety (CMUS) has investigated the effectiveness of health service interventions to improve analgesic use and appropriateness in residential aged care facilities.

Between 30 – 60 per cent of residents living in aged care facilities report daily pain, with unmanaged pain being associated with depressive and behavioural symptoms in dementia, increased risk of self-harm and reduced quality of life.

The CMUS team synthesised data from 16 studies of health service interventions, comprising 9056 residents across nine countries.

Overall, six of 16 interventions improved analgesic (painkiller) use or appropriateness, with all successful interventions involving prescribers collaborating with different health professionals, with evidence to support enhanced roles for pharmacists and nurses.

Providing education about analgesics was effective when combined with other interventions such as decision support, however providing education alone was only effective in one study. Implementing clinical practice guidelines and protocols was most successful when combined with staff education to enhance the uptake of guideline recommendations.

Previous CMUS research has found that up to 76 per cent of aged care residents are administered analgesic medicines on a daily basis. Ensuring safe and effective analgesic use is challenging as older adults are susceptible to adverse events, including falls, constipation and excess drowsiness.

Lead author and CMUS PhD candidate Laura Dowd said: “Our study suggests optimal pain management is much broader than whether or not residents are prescribed analgesics, but whether aged care facilities have systems in place to assess pain, tailor analgesic regimens, and monitor for possible analgesic adverse events.”

“The findings of our research provide the basis for developing multidisciplinary analgesic stewardship interventions in residential aged care.”

Ms Dowd will now work with CMUS Director Professor Simon Bell, Dr Amanda Cross and key stakeholders in medication management to develop evidence-based recommendations to improve safe and effective analgesic use.

The research was published this week in the prestigious Journal of the American Medical Directors Association.

CMUS is part of the Monash Institute of Pharmaceutical Sciences and specialises in multidisciplinary research into preventive, acute and chronic care, optimising medication management and patient safety.

The full study can be read here.

DOI: https://doi.org/10.1016/j.jamda.2021.09.024

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