Improving management of chronic pain for hospital inpatients living with frailty

Introduction

Chronic pain is highly prevalent among older adults, particularly those living with frailty.  It is associated with reduced mobility, falls and decline in quality of life.  When combined with ageing and frailty, the management of chronic pain becomes increasingly complex, so comprehensive assessment and management is vital in this patient group; unfortunately, studies have found that this is not routinely achieved. 

Method

Data was collected regarding local prevalence and management of chronic pain. 25 medical staff were surveyed regarding their confidence in management of chronic pain and knowledge of local pathways.  30 patients living with both frailty and chronic pain were surveyed in more depth to ascertain the impact of pain on their quality of life.  Following plan–do–study–act quality improvement methodology, interventions included use of a topic of the week board, provision of information and self-help booklets for patients experiencing chronic pain, teaching for medical staff, medication reviews, and development / distribution of a pain clinic referral guideline.

Results

Prevalence of chronic pain among hospital inpatients living with frailty was 60% (n=100).  Of the patients experiencing chronic pain, only 3% had been reviewed in a dedicated Pain Clinic. The EQ-5D-5L identified significant QoL impact.  Among medical staff we found limited confidence in chronic pain management.  Very few respondents had referred patients on to a dedicated clinic for pain management. 

Conclusion

This was a successful collaborative multidisciplinary project.  Following interventions, medical team confidence in pain management was found to be increased, with greater awareness of referral pathways and increased motivation to refer.  A pharmacist conducted medication reviews for all patients experiencing chronic pain.  Patient experience was improved through use of self-help materials.  The next stage of the project will address pain assessment and use of non-pharmacological pain management techniques by nurses and AHPs.