NP Adherence to Practice Protocol:
Management of Persistent Pain in Older Adults

George Peraza-Smith, APRN, DNP, FAANP1; DNP Chair2, GNP, DNP, FAANP
1South University, 2Case Western Reserve University

Abstract
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. Agism has had
a negative impact on the adequate assessment
and management of pain in older adults.
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 guidelines recommend
more reliance on opioid analgesia.. This
proposal aim is to implement an evidence-based
practice protocol on the pharmacological
management of persistent pain in older adults.

Background Information
An estimated 25% to 50% of older adults living
in the community and up to 80% of those in
nursing homes experience significant pain at
least some of the time. Undertreated persistent
pain in older adults has been linked to
depression, anxiety, cognitive impairment,
delirium, sleep disturbances, functional decline
and increased healthcare utilization and cost.
This project will implement a best practice so
that each older adult in a clinic will be assessed
and treated more effectively.

Persistent pain is a personal emotional and physical
experience.
Untreated or Inadequate Pain Management
• Persistent pain is under-recognized and under-treated
in older adults in many settings.
• Those with dementia have a greater risk for
inappropriate and inadequate pain treatment.

Pain Assessment with Older Adults
• Many older adults under-report their pain so as not to
be a burden.
• Numeric Rating Scale (1-10) has been shown
ineffective with older adults.
•IPT has high validity and reliability.

Opioid Use with Older Adults
• Guidelines support for persistent pain.
• Prescribing practice of opioids in older adults is mixed.

Literature Review

1.GSA. (2009). Pharmacological management of
persistent pain in older persons. Pain
Medicine, 10(6), 1062-1083.

2. Flaherty, E. (2021). Pain assessment for older
adults. ConsultGeri, 7.
https://hign.org/consultgeri/try-this-series/pain-
assessment-older-adults

References

Population (P): NP providers who make rounds in a 50-
bed skilled nursing facility
Intervention (I): Implementation of an evidenced-Based
Protocol on the management of persistent pain in adults
50 years and older
Comparison (C): Current practice of no protocol
Outcomes (O): 20% improvement in self-report pain
relief, 90% compliance rate of providers with protocol,
50% reduction on the use of NSAID with adults 50

The target population for this case are veteran men of age 45-50 years of age who are noted to be on higher risk of suicidal ideation and even suicidal attempts. These person or age group of Veterans have been identified to be at a risk by the US veteran Health Administration via the predictive modelling in the identification of veterans who are at a higher risk. The patients who have been enrolled in the VHA benefits are noted to be seeking care from the considered local veteran’s affair medical centers.

Week 7

I (Intervention) [100 to 200 words] Address the following questions/bullets in completing this section: · What are you planning to investigate or implement as a policy/process or program? · What are you doing that is different than what is currently happening? · List 2-3 potential actions that will be applied in this practice change. NOTE: Be very specific in your description.

The plans I am having on implementation of the strict follow up policies for the different patients normally involves having them being assessed and also labeled based on the groups having higher risk of suicidal ideations. The patients would then be provided with more personalized safety plan and follow up from a period of 3 months but the current practices would be varying from about 6months up to one year. These also needs to be provided the personalized safety plan as the patient families are also part of the establishment plan as it would help families on recognizing the suicidal ideations on one of their own and provided the most needed care.

*For purposes of this Proposal Project Form the assumption will be that the C (Comparison Group) is ‘traditional care or current care’

Week 8

O (Outcomes to be measured) [100 to 150 words] Every project is required to have an evaluation plan. Address the following questions/bullets in completing this section: · Which 2-3 outcomes are expected for your project? · What outcomes will be measured? · How do you plan to do this? · What tool will you be using to measure your outcome(s)? · What data will be used to validate success of the project? Be sure your outcomes link to the identified problem. · How will you know if your intervention resulted in change?

Increasing of the follow-ups with the help of the primary care givers for a p Week 9 & References In conclusion, the veteran men of the ages 45-50 years, who are having the risk of having suicidal ideation are noted to be needing follow up procedures which should be done for a period of about 3 months and be reinforced by having annual screening and thus playing an important role on having the risk reduced. The PICOT question also has been described as very important in explaining of the alarming rates of having suicide numbers being reported amongst the military veterans and other strategies which would be used on ensuring that the risk of suicide is reduced amongst the veterans ta all the ages. One of the competencies you would expect to use in the implementation of this project is leadership skills which is considered to be a complex and multi-faceted skills. The other one is quality adherence and assurance whereby this would be observed in the management plans and also in the products and services which are offered in the acre provision to person having suicidal thoughts or ideation. Lastly, is on having ethical observation and consideration which would be observed in the decision making, ethical reasoning and the leadership related skills which should be within the ethics of practice. MSN Capstone Project Proposal Form This is a building assignment that you will be completing over Week 1 through Week 9. This is a stepwise project proposal assignment in which you will complete one (1) section each week for your MSN Capstone Project Proposal. By the end of the Week 9, this form will have been filled in completely and your MSN Capstone Project Proposal will be completed. It is important that you keep up with the Weekly Assigned Section. Each section is graded separately on a weekly basis while the final completed form will be graded with an overall grade. Each week the student will receive feedback from the instructor and the student is expected to incorporate the instructor feedback to edit and improve the weekly sections. The Week 9 final Capstone Project Proposal with be based on students incorporating the instructor’s weekly feedback. How to use this form. · Must use the same form for all sections. The purpose is to have a completed the entire form by the end of the course. · Complete the week’s section with the requested information. · There are suggested word counts for each weekly section to provide you with an idea of what is expected. · You are to write in full sentences, paragraphs, correct grammar, and spelling. · Use APA formatting with citations and references list. · Refer to the MSN Capstone Project Proposal Form Example found in Week 1 and in the Course Resources tab. · Do not delete or edit the week section instructions. · Do not lock the form because that will stop you from editing and revising within the form. · Leave NO blank sections. All sections are graded separately. · You may work ahead; however, the instructor will only grade the week’s section due for the assigned week and the form must be submitted each week. · Read the item descriptions carefully. Items request very specific information. Be sure you understand what is requested. · Use primary sources for any references. Textbooks are not acceptable as references. Late Assignments: Students will receive a 10-point grade reduction for each day the assignment is submitted past the due date. After three (3) days past the due date, students will receive a zero (0) for that weekly section but must complete for the final Week 9 grading. MSN Capstone Project Proposal Form Student Name Ralph Marrero MSN Program Family Nurse Practitioner Project Title Depres Why work with us? Authenticity: All of our papers are authentic, as each paper of ours is composed according to your unique requirements. Confidentiality: We value you data. Our company is extremely efficient in guarding the privacy of our clients. 100% Money Back Guarantee: In the event you cancel your order, you get your money back as soon as possible, we give a 100% refund. 24/7 Support: Our team members are available via email, live chat, and phone. 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