What is the role of clinical practice guidelines to improve prescribing?
The American Geriatrics Society (AGS), the American Medical Directors’ Association (AMDA), and the American Pain Society (APS) have produced excellent guidelines with recommendations for pain management in long-term care (see Resources). The WHO analgesic ladder for pain management in persons with cancer provides guidance for the approach to non-cancer pain. However, some physicians in nursing homes view guidelines as rules that infringe upon professional autonomy and create additional work burden (see abstract). Nurses and pharmacists can also perceive guidelines as burdensome because of mandated documentation and paperwork. So the regulatory framework in US nursing homes provides disincentives for prescribing and there is a need to increase adherence to clinical guidelines to improve pain management. Q: What about an approach that emphasizes collaboration among providers? A: Collaborative methods can significantly improve processes of care. Nursing homes need to move away from a hier
