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Biomedical subjects

Gail Ardery

Publications and source records attributed to Gail Ardery.

7 recordsLinked to original sources
PubMed2004

Measuring adherence to practice guidelines for the management of hypertension: an evaluation of the literature.

Adherence to practice guidelines is frequently used as a measure of quality of care. Numerous studies have evaluated physician adherence to hypertension guidelines by prescription data, physician survey data, or medical record review. However, most have methodological limitations that might underestimate physician adherence. Accurate and meaningful characterization of adherence rests on evaluation of varied components of hypertension care, use of explicit validated performance measures, incorporation of implicit and explicit review, and linkage of process measures to blood pressure outcomes.

Guideline Adherence↗
PubMed2003

Acute pain treatment for older adults hospitalized with hip fracture: current nursing practices and perceived barriers.

This article examines acute pain management practices for patients 65 years of age and older who were hospitalized during 1999 for hip fracture. Data were collected from the medical records of patients (N = 709) admitted to 12 hospitals in the Midwest and from questionnaires on pain practices completed by nurses (N = 172) caring for these patients. The major variables examined were (1). pharmacological and nonpharmacological treatments for acute pain in hospitalized elders, (2). nurses' perceived stage of adoption for avoiding meperidine use and for administering analgesics around-the-clock, and (3). nurses' perceived barriers to optimal treatment of acute pain in elders. Acetaminophen was the most frequently administered analgesic, but administered doses were far less than the maximum daily recommended dose. More than one third (39%) of the nurses reported that they always avoided the use of meperidine, and over half reporting avoiding its use sometimes. However, the majority of patients (56.8%) received at least one dose of meperidine, even though evidence suggests that other analgesic agents are more appropriate for treatment of acute pain in elders. Only 27% of patients received patient-controlled analgesia, and only 22.3% of patients received around-the-clock administration during the first 24 hours after admission of analgesics that had been ordered on a prn basis. The majority of nurses were aware that around-the-clock administration of analgesics was preferable, but only 33.7% were persuaded (believed) that this method should be used. Intramuscular injection was used for 52.2% of patients, even though this route is not recommended for older adults. The most frequently used nonpharmacological intervention was repositioning, followed by use of pressure relief devices and cold application. Nurses reported difficulty contacting physicians and difficulty communicating with them about type and/or dose of analgesics as the greatest barriers to pain management. Findings from this multi-site study show that active and focused "translation" interventions are needed to promote adoption of evidence-based acute pain management practices by health care providers.

Acute Disease↗
PubMed2003

Assessing and managing acute pain in older adults: a research base to guide practice.

Older adults experiencing acute pain are often underassessed and undertreated. This review summarizes recommendations from an evidence-based practice guideline on acute pain management in older adults. Key areas highlighted are pain assessment and monitoring, patient education, pharmacologic management, and nonpharmacologic management.

Acute Disease↗
PubMedDate not supplied

Lack of opioid administration in older hip fracture patients (CE).

As part of a multisite study funded by the Agency for Healthcare Research and Quality, the medical records of older adults with a hip fracture were abstracted for acute pain assessment and treatment practices. Of the 709 records reviewed, 8 patients did not have an opioid administered during the first 72 hours after admission to a non-intensive patient care unit. Using a case study approach, this article examines demographic characteristics, pain assessment, and analgesic administration for these 8 patients to illustrate specific practice problems that occur in managing acute pain in older adults. Pain intensity was documented infrequently. All 8 patients had a physician order for some type of analgesic, and 7 of the 8 had an order for an opioid analgesic. Yet none received an opioid during the first 72 hours of care on a general medical-surgical unit, and one patient received no analgesia of any kind. The medical records of these hip fracture patients indicate that acute pain was underassessed and undertreated. Provision of quality pain management will require that nurses address the specific practice behaviors identified in the article and correct problems where they exist. Key strategies that can be used to improve pain management practices include implementation of standardized assessment tools and pain flow-sheets, audit and feedback of pain management data with staff, use of pain management opinion leaders and change champions, and incorporation of research-based pain management practices into performance-evaluation criteria.

Acute Disease↗
PubMedDate not supplied

Evidence-based assessment of acute pain in older adults: current nursing practices and perceived barriers.

OBJECTIVES: To report data on current nurse practice behaviors related to evidence-based assessment of acute pain in older adults, perceived stage of adoption of pain assessment practices, and perceptions of barriers to optimal assessment in this population. METHODS: Medical records from 709 older adult patients hospitalized with hip fractures from 12 acute care settings were abstracted for nurse assessment practices during the first 72 hours after admission. Questionnaires sent to nurses on study units regarding perceived stage of adoption and barriers to assessment in older adults. RESULTS: Data revealed several areas in which pain assessment practices were not optimal. Pain was not routinely assessed every 4 hours, and pain location was assessed even less frequently. Pain behaviors were assessed more in patients with a diagnosis of dementia compared to those without dementia, but the frequency of pain behavior assessments was low. Pain was not routinely assessed within 60 minutes of administering an analgesic. Nurses reported not using optimal pain assessment practices even when they were aware of and persuaded that those practices were desirable. In addition, nurses reported that difficulty communicating with patients created the greatest challenge in managing pain. CONCLUSIONS: Our data suggest that pain is not being assessed and reassessed in a manner that is consistent with current practice recommendations in older adult patients with pathologic processes that highly suggest the presence of acute pain.

Aged↗
PubMedDate not supplied

Challenges of Web-based education in educating nurses about evidence-based acute pain management practices for older adults.

Internet technology holds potential as a valuable educational tool, but several challenges continue to impede its use. This article describes the use of a web-based course to educate staff nurses regarding evidence-based acute pain management practices for older adults. Specific areas highlighted include: the steps involved in creating the web-based course; the materials and support required to disseminate the course; the challenges encountered in promoting use of the course; and responses to and evaluations of the course. The authors' experiences provide knowledge to assist other healthcare professionals on the use of a web-based course to educate staff nurses.

Adult↗