Introduction

Older individuals have a high prevalence of chronic or persistent pain that negatively impacts quality of life measures and functionality, and approximately 45% - 80% of long-term care facility (LTCF) residents are estimated to suffer from chronic pain. (Jablonski A, Ersek M. J Gerentol Nurs. 2009;35:28-34) This issue needs to be addressed as the aging population continues to grow and increasing numbers of individuals will be residing in LTCFs. A performance improvement CME activity was developed to help clinicians in LTCFs improve the assessment and treatment of their residents’ neuropathic pain. During the course of the activity, the scope and resulting resources were expanded to include persistent pain. This toolkit was based on the PI CME activity and provides clinicians with additional LTCF tools, resources and strategies to implement their own performance improvement activity.

This QI CME activity was co-sponsored by The Academy for Continued Healthcare Learning and the University of Michigan Medical School, and supported by an educational grant from Pfizer, Inc.

Instructions for Implementation

This toolkit was created based on a completed performance improvement CME activity, and accordingly is designed on the following model of performance or quality improvement:

1. Stage A: Learning from current practice performance assessment
2. Stage B: Learning from the application of PI to patient care
3. Stage C: Learning from the evaluation of the PI effort

Instructions for Stage A:

1. Review a minimum of 25 patient charts (or another number determined to be appropriate) from patients/residents within the past 6 months, and complete the attached Data Collection Form, one form per patient chart
2. Calculate and analyze how residents were evaluated and treated for persistent pain based on the provided Performance Measures and Calculation Instructions
3. Set goals for performance improvement

Instructions for Stage B:

1. Educate LTCF on best practices; PowerPoint slides used for clinical in-service meetings are attached, and/or you can use other sources to customize the education as needed
2. Develop and implement action plans for improvement (at the facility level and/or clinician level, as determined to be relevant and appropriate)

Instructions for Stage C:

1. Allow several weeks for the action plan(s) to take effect—the amount of time needed will depend on several factors, including the specific actions taken and number of residents with pain
2. Identify 25 new residents (or another number determined to be appropriate) admitted to LTCF since completion of Stage B, and complete the attached Data Collection Form, one form per patient chart
3. Calculate and analyze how residents were evaluated and treated for persistent pain based on the provided Performance Measures and Calculation Instructions
4. If desired, set new performance goals again and repeat Stages B and C to reach desired outcomes

Resources for Stage B Interventions/Action Plans

Below is a list of resources and activities available to Long –Term Care Facilities (LTCF) and clinicians, for implementation as part of Stage B. Please select the education to include in action plans based on what is most relevant to your needs, and the actions that you feel will be most helpful in achieving the goals identified. This is not a comprehensive list of resources or interventions available for Stage B; you may determine other education or action plan components that are more relevant based on your specific performance goals.