TY - JOUR
T1 - Identifying Residents Who May Benefit from an Analgesic Review
T2 - Applying Analgesic Indicators in Residential Aged Care Services
AU - Dowd, Laura A.
AU - Cross, Amanda J.
AU - Liau, Shin J.
AU - Jadczak, Agathe D.
AU - Visvanathan, Renuka
AU - Veal, Felicity C.
AU - Bell, J. Simon
N1 - Funding Information:
Renuka Visvanathan was previously a board member and member of the clinical governance committee of Resthaven Inc. She recently received honorarium for participation in workgroups from HealthConsult Pty Ltd in relation to a Commonwealth Funded project, and in the past has received honoraria and speakers and educational grants in various combinations from Nutricia, Abbott and Nestlé. J. Simon Bell has received grant or consulting funds from the NHMRC, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Australian Commission on Safety and Quality in Health Care, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations, all paid to Monash University. Laura A. Dowd, Amanda J. Cross, Shing J. Liau, Agathe D. Jadczak and Felicity C. Veal declare no conflicts of interest.
Funding Information:
The FIRST study and ADJ were funded through project funding to RV from the Healthy Aging Research Consortium funded by the South Australian Department for Innovation and Skills, Hospital Research Foundation and Resthaven Inc. LAD and SJL were supported by postgraduate research scholarships funded by Monash University. AJC was supported by a National Health and Medical Research Council (NHMRC) Emerging Leadership Fellowship. SJL, RV, and JSB were supported by the NHMRC Centre of Research Excellence in Frailty and Healthy Ageing. SJL was supported by the Australian Government Research Training Program Scholarship. JSB was supported by the NHMRC Boosting Dementia Research Leadership Fellowship. Open Access funding enabled and organized by CAUL and its Member Institutions.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/5/6
Y1 - 2023/5/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85158102811&partnerID=8YFLogxK
U2 - 10.1007/s40266-023-01025-5
DO - 10.1007/s40266-023-01025-5
M3 - Article
C2 - 37147416
AN - SCOPUS:85158102811
SN - 1170-229X
VL - 40
SP - 449
EP - 459
JO - Drugs & Aging
JF - Drugs & Aging
ER -