Level of implementation of pain management and early mobilization strategies to prevent delirium in geriatric trauma patients: A mixed-methods study

Maryline Beaudoin; Etienne L Belzile; Céline Gélinas; David Trépanier; Marcel Émond; Marc-Aurèle Gagnon; Mélanie Bérubé

doi:10.1016/j.ijotn.2023.101050

Level of implementation of pain management and early mobilization strategies to prevent delirium in geriatric trauma patients: A mixed-methods study

Int J Orthop Trauma Nurs. 2024 Feb:52:101050. doi: 10.1016/j.ijotn.2023.101050. Epub 2023 Sep 29.

Authors

Maryline Beaudoin¹, Etienne L Belzile², Céline Gélinas³, David Trépanier⁴, Marcel Émond⁵, Marc-Aurèle Gagnon⁶, Mélanie Bérubé⁷

Affiliations

¹ Faculty of Nursing, Laval University, Quebec City, QC, Canada; Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada. Electronic address: Maryline.Beaudoin.3@ulaval.ca.
² Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Department of Orthopaedic Surgery, CHU de Quebec- Laval University, Quebec, QC, Canada.
³ Quebec Pain Research Network, Sherbrooke, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal, Montreal, QC, Canada; Ingram School of Nursing, McGill University, Montreal, QC, Canada.
⁴ Department of Emergency and Family Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
⁵ Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Department of Emergency and Family Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.
⁶ Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Enfant-Jesus Hospital), Quebec City, Quebec City, QC, Canada.
⁷ Faculty of Nursing, Laval University, Quebec City, QC, Canada; Research Center of the CHU of Quebec- Laval University, Quebec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada; Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Enfant-Jesus Hospital), Quebec City, Quebec City, QC, Canada.

PMID: 37848364
DOI: 10.1016/j.ijotn.2023.101050

Abstract

Background: Pain management and early mobilization strategies are recommended in clinical practice guidelines for the prevention of delirium in older adults. However, available data on the implementation of these strategies in trauma are limited.

Aims: To describe the use of pain management and early mobilization strategies in older adults at a level I trauma center, as well as the facilitators and barriers to their implementation.

Methods: A convergent mixed methods study was used. Quantitative data were collected from sixty medical records. Qualitative data was collected through a focus group with healthcare providers to explore their perspectives regarding the use of the target practices and on barriers and facilitators to their implementation. Descriptive statistics were calculated, and a thematic analysis using an inductive and deductive interpretative descriptive approach was undertaken.

Results: A question on the presence/absence of pain was the most frequently documented pain assessment method. Pain assessment was poorly documented. Frequencies of non-opioid and opioid administrations were similar, but non-pharmacological strategies were not widely used. The first mobilization was performed quickly and was most commonly to a chair. The focus group discussion confirmed many of the data collected in the medical records. Barriers to implementing the targeted strategies were primarily related to organizational context and facilitation processes.

Conclusions: Areas for improvement were identified including pain assessment, the use of non-pharmacological pain management strategies and ambulation as a mobilization strategy. Our findings will serve as a starting point for optimizing and adapting practices for geriatric trauma patients and evaluating their impact.

Keywords: Delirium; Early mobilization; Geriatric trauma; Mixed-methods; Pain management; Practice guidelines.

MeSH terms

Aged
Delirium* / prevention & control
Early Ambulation
Focus Groups
Humans
Pain / etiology
Pain / prevention & control
Pain Management* / methods