Collaboration key to good painkiller use

A Monash University study has found the most successful interventions for improving painkiller use in aged care involve a multidisciplinary approach.

A teamwork approach between prescribers, pharmacists and nurses is the most effective way to improve the use of painkillers in aged care facilities, a Monash University study has found.

The study, published in the Journal of the American Medical Directors Association, explored the effectiveness of interventions to improve analgesic use and appropriateness in residential aged care facilities.

Researchers at Monash University’s Centre for Medicine Use and Safety synthesised data from 16 studies health service interventions involving 9,056 residents across nine countries.

The study builds on previous CMUS research findings that about three-quarters of aged care residents in Victoria receive analgesics, such as paracetamol, opioids and non-steroidal anti-inflammatory drugs, daily.

Lead researcher and CMUS PhD candidate Laura Dowd said the study classified the 16 interventions as either educational, decision support aid, system modification or medication reviews.  

Laura Dowd

“Of all the 16 interventions, six of those changed the use of those analgesic medications or the appropriateness of the medications,” Ms Dowd told Australian Ageing Agenda.  

“All six involved prescribers collaborating with pharmacists and nurses.”

Five of the six interventions involved multidisciplinary collaboration and five included a component of education. Only one of the six interventions was an education-only intervention, Ms Dowd said.

“There’s evidence to support enhanced roles for pharmacists and nurses in terms of medication review and collaborating with other health care professionals,” she said.

The study also found interventions that combined decision support aids and education were also promising.

“Decision support aids were effective when combined with staff education to enhance the uptake of the guideline or protocol,” Ms Dowd said.

It is surprising only six of the interventions changed the use of analgesics. But it isn’t surprising that multidisciplinary collaboration is a successful element of interventions, she said.

“We know that communication and collaboration increase the care across a number of settings,

Ms Dowd said the findings highlight the existence of gaps in managing pain in aged care.

“It shows we still don’t know the ideal treatment option for pain. It’s multi-dimensional and complicated. It’s tricky to know how best to manage pain,” she said.

Analgesic stewardship model needed

The findings provide the basis for developing multidisciplinary analgesic stewardship interventions in residential aged care, Ms Dowd said.

“The study suggests that pain management is far broader than whether residents are simply prescribed these medications or not, and whether the facilities have systems in place to ensure that these medications are being used appropriately,” she said.

“Aged care facilities do a good job at ensuring medications are used appropriately. But a stewardship model provides a structured way of ensuring that pain is effectively managed as well as potential adverse events to these medications are controlled for and being monitored for.”

Aged care homes should have systems to assess regularly pain regularly.

“Is there a system in place for someone to potentially check that they may need a review of a regular medication to balance out that analgesic regimen?” she said.

Access the study

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Tags: aged care, analgesic, centre for medicine use and safety, laura dowd, monash university, painkillers,

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