PAIN-AGE, a Controlled Before/After Study Assessing an Audit and Feedback Perioperative Pain Management Intervention in Older Patients with Hip Fracture.

Abstract Background Pain in older adults is historically neglected. The study assessed the ability of an audit and feedback (A&F) intervention built with nurses to improve the quality of perioperative pain management in older patients hospitalized for hip fracture. Methods Controlled before/after study in an orthogeriatric unit (experimental group); a conventional orthopedic unit served as control (no intervention). Quality of perioperative pain management was evaluated based on acetaminophen distribution and prescription adherence. The primary endpoint was the evolution of the percentage of patients who received 3g/day of acetaminophen during the three postoperative days. Secondary endpoints included nurses’ adherence to medical prescriptions and factors associated with intervention. The significative level was set at 0.05 for statistical analysis. Results We studied data from 398 patients (mean age, 89 years). During the postoperative period, 16% of patients from the experimental group received 3g/day of acetaminophen before the A&F intervention; the percentage reached 60% after the intervention. The likelihood of receiving 3g/day of acetaminophen during the postoperative period and adhering to the medical prescription of acetaminophen were significantly increased in the experimental group as compared with the control group. The patient’s functional status at discharge (assessed by Activities of Daily Living scores) was significantly better and the length of hospital stay significantly reduced after the A&F intervention. Conclusion Our controlled before/after study showed that an A&F intervention significantly improved perioperative pain management in older adults hospitalized for hip fracture. Involving teams in continuous education programs appears crucial to improve the quality of pain management and ensure nurses’ adherence to medical prescriptions.