Pain Management and Pain

¶ … Best Practices for the Pain Management of Broken Hips Achieving the Institute of Medicine's goal of ensuring that 90% of health care decisions are evidence-based by 2020 will require identifying current gaps between research, findings, and practice implementation. One practice identified in the Agency for Healthcare Research and Quality (AHRQ) comparative effectiveness research site concerns pain management for broken hips. This paper examines a gap that currently exists between research findings and the implication of those findings in this practice, followed by a summary of the research in the conclusion.

Discussion of the practice Although anyone can break a hip, broken hips are more common among the elderly and can be caused by a fall or simply by the weakening of the femur with age (Managing pain from a broken hip, 2011). For instance, the AHRQ reports that, "[The incidence] of hip fractures increases substantially with age, rising for men and women, respectively, from 22.5 and 23.9 per 100,000 populations at age 50, to 630.2 and 1,289.3 per 100,000 populations by age 80" (Pain management interventions for hip fracture, 2011, p. 1).

Without effective pain management, though, people, especially the elderly, who suffer a broken hip can experience delirium, sleep disruption and depression. In addition, ineffective pain management for broken hips can also adversely affect treatments for other medical conditions (Managing pain from a broken hip, 2011). Although a number of pharmacological interventions are available to ensure effective pain management for people with broken hips, clinicians may not fully realize the severity of the pain that is involved as discussed further below.

Assessment concerning the extent to which the practice is being implemented While a number of pain management options are available for patients suffering from severe pain, many clinicians fail to provide adequate pain management therapy (Moore & Anderson, 2016). The Joint Commission promulgated pain management standards in 2001 in response to the ubiquitous problem of poor pain management practices (Baker, 2017). According to Baker, "The Joint Commission's current standards require that organizations establish policies regarding pain assessment and treatment and conduct educational efforts to ensure compliance" (2017, para. 2).

These standards, however, are not being followed in far too many cases for the reasons discussed below. Evaluation of the barriers to implementation into practice There are several reasons for the failure of clinicians to follow pain management guidelines, including (a) organizational and administrative barriers to providing effective care; (b) inadequate or limited training in pain management therapies; (c) low confidence in their ability to care for patients with severe pain; and (d) reservations concerning the treatment of chronic pain (Moore & Anderson, 2016).

In addition, the research to date indicates there is wide variability in the adherence to guidelines for pain management and the documentation of comprehensive pain care plans and the specific treatment provided remains suboptimal (Moore & Anderson, 2016). Proposed ways to overcome the barriers Overcoming organizational barriers to effective pain management for hip fractures can be generally facilitated by adherence to the Joint Commission's foundational standards for pain management as follows: • The hospital educates all licensed independent practitioners on assessing and managing pain.

• The hospital respects the patient's right to pain management. • The hospital assesses and manages the patient's pain (Baker, 2017, para. 3). In addition, overcoming the low confidence of practitioners and their reservations about treating pain can be facilitated by adherence to the Joint Commission's requirements for pain management practice as follows: 1. The hospital conducts a comprehensive pain assessment that is consistent with its scope of care, treatment, and services and the patient's condition. 2.

The hospital uses methods to assess pain that are consistent with the patient's age, condition, and ability to understand. 3. The hospital reassesses and responds to the patient's pain, based on its reassessment criteria. 4. The hospital either treats the patient's pain or refers the patient for treatment (Baker, 2017, para. 5). Discussion concerning the resources available on the selected site to inform translation The AHRQ site has a number of useful resources available concerning best practices for pain management for broken hips, including pain management interventions for hip.