A Changed Approach in the Management of Chronic Non-Cancer Pain in Older Adults

Inappropriate use of opiate medication for the management of chronic pain by older adults is fraught with challenges for the patient as well as healthcare providers.  The Drug Enforcement Agency (DEA) recently changed the scheduling of hydrocodone combination products which created an opportunity to change pain management prescribing patterns and use for our elderly patients.   The number of older adults, with their ever more complex needs, will continue to increase as the baby boomers age in our country thus having nurse leaders poised to address these needs within a climate of change is necessary.  Furthermore, in the current health care climate and in the midst of the current Affordable Care Act, effective interprofessional leadership is needed in order to facilitate effective change.  The Geriatric Nurse Leadership Academy (GNLA) sponsored by Sigma Theta Tau International in partnership with Hill Rom and the Hearst Foundation, provides an excellent opportunity for the community based geriatric nurse practitioner to develop their leadership knowledge and skills in order to provide effective leadership through this changing healthcare climate.  The purpose of the GNLA is to prepare and support a group of nurses to develop and implement an interprofessional project centered on improving geriatric health outcomes.  Using multiple methodologies in order to develop leadership knowledge and competence, the Fellow develops their skills in three domains throughout their GNLA Fellowship:  individual leadership, advance nursing practice through leadership of an interprofessional team project and expand their scope of influence in their organization, community and profession.   The GNLA utilizes the Kouzes and Posner leadership model in order to build on existing skills as well as to learn new leadership strategies.  Utilizing these leadership strategies, the Fellow was instrumental in developing and leading an interprofessional team (pharmacists, pain experts, addiction medicine, physicians, nurses and social work) to develop a protocol for opiate use in the Rosa Parks Geriatric Wellness Institute for Senior Health (RP-WISH) patient.  The purpose of the study was to provide effective and appropriate opiate alternatives to manage chronic pain in the older adult after determining the current opiate utilizations rates of the RP-WISH patient and in so doing implement a practice model change.  Provider and patient education modules were developed with subsequent standardization in the RP-WISH procedures used with an opiate using patient, such as utilizations of a pain contract, urine drug screening as appropriate, patient and pain assessment tools, etc.  Furthermore, the Pain Management Model was used to guide the project and give it a theoretical underpinning in order to maintain our focus of providing care to the older adult in such a way as to keep them functional and as independent as possible while promoting their overall quality of life, reducing their pain by addressing their pain from a biopsychosocial perspective and utilizing medications and other procedures in a judicious manner.  Utilizing the leadership of an interprofessional team as a vehicle, the Fellow was able to use these newly acquired leadership skills to position herself in order to impact her organization by changing policy and procedures with regards to the care of the older adult opiate using patient, her community by participating with the DEA on a task force regarding opiate use/abuse and her profession by disseminating learned information in the effective and efficient care of the older adult patient in chronic pain.