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Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services

BACKGROUND: Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). OBJECTIVE: The aim of this study was to identify the proportion and characteristics of residents of aged care ser...

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Autores principales: Dowd, Laura A., Cross, Amanda J., Liau, Shin J., Jadczak, Agathe D., Visvanathan, Renuka, Veal, Felicity C., Bell, J. Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198878/
https://www.ncbi.nlm.nih.gov/pubmed/37147416
http://dx.doi.org/10.1007/s40266-023-01025-5
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author Dowd, Laura A.
Cross, Amanda J.
Liau, Shin J.
Jadczak, Agathe D.
Visvanathan, Renuka
Veal, Felicity C.
Bell, J. Simon
author_facet Dowd, Laura A.
Cross, Amanda J.
Liau, Shin J.
Jadczak, Agathe D.
Visvanathan, Renuka
Veal, Felicity C.
Bell, J. Simon
author_sort Dowd, Laura A.
collection PubMed
description BACKGROUND: Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). OBJECTIVE: The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. METHODS: Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study (N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. RESULTS: Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. CONCLUSIONS: Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40266-023-01025-5.
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spelling pubmed-101988782023-05-21 Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services Dowd, Laura A. Cross, Amanda J. Liau, Shin J. Jadczak, Agathe D. Visvanathan, Renuka Veal, Felicity C. Bell, J. Simon Drugs Aging Original Research Article BACKGROUND: Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). OBJECTIVE: The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. METHODS: Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study (N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. RESULTS: Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20–2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12–2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29–0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. CONCLUSIONS: Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40266-023-01025-5. Springer International Publishing 2023-05-06 2023 /pmc/articles/PMC10198878/ /pubmed/37147416 http://dx.doi.org/10.1007/s40266-023-01025-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research Article
Dowd, Laura A.
Cross, Amanda J.
Liau, Shin J.
Jadczak, Agathe D.
Visvanathan, Renuka
Veal, Felicity C.
Bell, J. Simon
Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services
title Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services
title_full Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services
title_fullStr Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services
title_full_unstemmed Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services
title_short Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services
title_sort identifying residents who may benefit from an analgesic review: applying analgesic indicators in residential aged care services
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198878/
https://www.ncbi.nlm.nih.gov/pubmed/37147416
http://dx.doi.org/10.1007/s40266-023-01025-5
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