Management of Breakthrough Pain in Hospitalized Older Adults

The appropriateness of analgesic administrations based on pain score and medication order in older adults during hospitalization was evaluated.

As-needed analgesic administrations for geriatric patients on hospitalist general medicine services at a large-university-affiliated medical center from January 1 to March 31, 2015, were included.

The hospital is a level one trauma center with more than 500 beds serving an area of more than 500,000 people, 12% of whom are 65 years of age or older. At our institution, breakthrough pain is treated with as-needed analgesic medications based on pain scores specified by the ordering provider. Medication should be given according to which order contains the patient-reported severity of pain.

This is an institutional review board-approved retrospective chart review of 430 analgesic medication administrations in hospitalized older adults.

Incidence of appropriate medication administration based on pain score report and active medication orders.

As-needed analgesic medications were given appropriately 44% of the time based on patient-reported pain score and active medication order. An active medication order was missing to treat the pain score reported by the patient 29% of the time. Out of 430 analgesic administrations, improvement in pain occurred 26% of the time. Pain was reassessed one hour after administration for almost 33% of the orders. Of those, 73% showed an improvement in pain score.

Our results demonstrate a large discrepancy for hospitalized older adults in what medication is administered compared with what is ordered for as-needed pain treatment. Missing orders contributed to almost one third of inappropriate medication administrations.