Assignment Week 8 Antiseptic barrier caps

In adult hospitalized patients ages 25 and over, how does the use of antiseptic barrier caps compare to manual alcohol swabs in the prevention of central line infections within one year?

I have to write the final paper on the following topic

My capstone topic: Prevention of Central Line-Associated Bloodstream Infection (CLABSI) using antiseptic barrier caps

Assignment Prompt

This is a final project designed to utilize the various skills learned in the program. The capstone project is completed and is developed as a scholarly paper. The body of the paper will be 15 pages.

The capstone project encompasses the following sections:

1. Title page

2. Abstract

3. Background & Significance

4. Literature Review

5. Supporting Evidence

6. Purpose or Aims of the Study

7. Theoretical Model or Framework

8. Methods/Design/Sampling

9. Proposed Interventions

10. Expected Results/Outcomes

11. Anticipated Conclusion

12. Possible Limitations

13. Potential Implications to Practice

14. References

15. Poster

16. Appendices

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Background & Significance: Pharmacological management of persistent pain in older adults continues to evolve. Even though persistent pain is highest among older adults, they have been insufficiently represented in clinical trials and studies on the management of persistent pain. Past clinical practice guidelines addressing pain in older adults primarily recommended non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) selective inhibitors as analgesics of choice after acetaminophen. Evidence has emerged indicating serious risk for cardiovascular, gastrointestinal and renal dysfunction with consistent use of NSAIDs and COX-2 analgesics. Other evidence supports the efficacious use of opioid analgesic in the treatment of moderate-to-severe persistent pain in older adults. Updated clinical practice guidelines recommend more reliance on opioid analgesic for the treatment and management of persistent pain in older adults. Assignment Week 8 Antiseptic barrier caps

PICOt Question:

Population/Problem – Older adults 75 years and older who experience persistent pain and who reside in a nursing home.

Intervention – The implementation of the Persistent Pain Management Care Bundle.

Comparison – Traditional Care.

Outcome – Decreased self-reported pain ratings, improved patient satisfaction, improved health-related quality of life.

Time – Three months.

Methods/Design: The methods for this study will be a quality improvement project with an interventional design comparing outcomes from prior to implementation of an intervention care bundle with outcomes from post implementation of the intervention care bundle. The SQUIRE guidelines will be used to guide the study (SQUIRE, 2008). The setting for this project will be on a 46-bed skilled nursing and custodial unit. The sample will be 50 older adults 75 years and older with persistent pain.

Proposed Intervention: Five interventions will be used in a care bundle. The interventions are derived from the American Geriatrics Society (2009) guideline titled Pharmacological Management of Persistent Pain in Older Persons focused recommendations on an older population 75 years and older.

Expected Outcomes: The expected outcomes of the proposed quality improvement study included improved recognition and management of persistent pain in older adults 75 years and older residing in XYZ Nursing Home. Three specific outcomes will be evaluated in this study: 1) decreased self-reported pain ratings (NRS); 2) improved patient satisfaction (Care and Pain Management); and 3) improved quality of life (SF-36). An additional expected outcome would be that providers and staff will have a deeper understanding of pain management with this population and will translate pain management improvements to other patient and resident populations.

Keywords: long-term care, older adult, opioid, persistent pain, practice guidelines

Implementing a Care Bundle for Persistent Pain in Older Adults

75 Years Old and Older Residing in a Nursing Home

Background & Significance

Over the past two decades pain has garnered more attention with the intro-duction of pain as the fifth vital sign (Curtiss, 2001; Walid, Donahue, Darmohrary, Hyer, & Robinson, 2008). As the fifth vital sign, pain is regarded as equally important as the assessments of temperature, blood pressure, heart rate and respiratory rate. With increasing age likely come physical illnesses that can lead to significant pain for older adults (Baumann, 2009). The management of pain presents several unique challenges in older adults due to ageist beliefs by both the older adult and the provider. Many believe pain to be a part of aging and accept pain as normal (Jones & Macfarlane, 2005). In addition, many older adults do not want to be a “bother” and may become discouraged from making unacknowledged requests for treatment of their pain (Jones, et al., 2006; Malanga & Paster, 2007). Assignment Week 8 Antiseptic barrier caps

In the literature the terms chronic pain and persistent pain are used interchangeably with persistent pain being preferred because it is less likely to be associated with the negative attitudes and stereotypes that clinicians and patients often associate with the chronic pain label (American Geriatric Society [AGS], 2002, Woo, et al., 2008). Persistent pain affects just over 76 million Americans—more than diabetes (20.8 million), heart disease (18.7 million), and cancer (1.4 million) combined (American Pain Society, 2011; Walid, et al., 2008). It is estimated that 25-50% of older adults living in the community experience significant pain at least some of the time (Sawyer, Bodner, Ritchie, & Allman, 2006) while 44-80% of nursing home residents experience persistent pain (AGS, 2002; Jones, Vojir, Hutt, & Fink, 2007). Older persons are more likely to experience persistent pain than younger persons (McLennon, Adams, & Titler, 2007) and there is an increased incidence of persistent pain with age (Hager & Brockopp, 2009). It is predicted that 80-85% of individuals will experience a significant health problem that predisposes them to pain after the age of 65 years (AGS, 2009) and 80% of older persons with cancer report pain (Miaskowski, 2010).

There is an emergent focus and evidence on effective pain assessment and management strategies. However, this increased focus on pain assessment and management has not necessarily improved adequate management of pain in the elderly. Evidence has emerged on the serious cardiovascular and gastrointestinal tract risk associated with the consistent use of nonsteroidal anti-inflammatory drugs (NSAIDs) and Cyclooxygenase-2 (COX-2) inhibitors (AGS, 2009; Auret & Schug, 2005; Hanlon, Backonja, Weiner & Argoff, 2009). NSAIDs have also been associated with a wide range of renal dysfunctions (Pratt, Roughead, Ryan, & Gilbert, 2009). Other evidence has revealed that these drugs may complicate the treatment of common medical conditions in older adults, such as hypertension and congestive heart failure (Kuehn, 2009). Data is emerging on the efficacy of the use of opioid analgesics for the treatment of moderate to severe persistent pain in older adults (Auret & Schug, 2005; AGS, 2009; Planton & Edlund, 2010).

Remaining aware and knowledgeable of the latest evidence and practice guideline recommendations can pose a significant challenge for the provider practicing in long-term care. The plethora of information available for implementing evidence-based practice can be overwhelming (Kent & Fineout-Overholt, 2007). Several national associations have published clinical guidelines on persistent pain management. The American Society of Anesthesiologist Task Force on Pain Management (2010), the American Medical Directors Association (2009) and the AGS (1998, 2002, 2009) have developed practice guidelines on managing persistent pain. AGS’s (2009) guideline titled Pharmacological Management of Persistent Pain in Older Persons focused recommendations on an older population 75 years and older. Since the guideline was first published in 1998, it has been reviewed and revised with some minor updates in 2002 and significant updates in the current 2009 edition. The primary evolution in the development of the AGS’ guidelines have been a shift away from NSAIDs and Cox-2 inhibitors as the primary recommendations of pharmacological management of persistent pain in older adults to the use of opioid analgesics for moderate to severe persistent pain in older adults (Smith, 2011). Assignment Week 8 Antiseptic barrier caps

Problem Description

Managing persistent pain in older adults residing in nursing homes offers several challenges from the resistance of older adults to opioid therapy to the ageist beliefs on pain in the elderly of facility staff to providers’ ignorance to evidence-based pain management strategies. This problem was first identified at the XYZ Nursing Home when resident’s request for pain relief was being minimized and ignored by staff and providers. This phenomenon was especially significant in residents over the age of 75 years old with persistent pain where the persistent pain was being under-recognized, under-assessed and under-treated. The nursing home administration identified the following areas for improvement: inaccurate staff and provider knowledge, inadequate assessment and management of pain, and insufficient documentation systems. A quality improvement team was convened to explore and implement revised systems to improve the assessment and management of persistent pain in nursing home residents over the age of 75 years.