Gerontological Nursing Interventions Research Center (GNIRC)

Title: TRIP Toolkit for Evidence-Based Elder Pain Management

Principal Investigator: Marita Titler, PhD, RN, FAAN

Study Site: University of Iowa

Abstract

This experimental study is the next phase of our research program that promotes nurse and physician adoption of evidence-based practices (EBPs) in delivery of acute care services. Findings from our previous research demonstrated that the Translating Research into Practice I (TRIP I) intervention saves healthcare dollars ($1496/patient), improves quality of acute pain management for hospitalized elders, and results in lower pain intensity.  The purpose of the proposed study is to test the effect of a different delivery mechanism, the TRIP Toolkit intervention, on promoting adoption of evidence-based acute pain management practices for hospitalized older adults. The TRIP Toolkit intervention differs from the externally directed, TRIP I intervention, in that it is internally directed, requires application of tools by the hospitals rather than the research team, and uses a group of TRIP I strategies based on quantitative and qualitative results from our previous study that are converted into an electronic format.  Specific aims are to: 1) test the effect of the TRIP Toolkit intervention on promoting physician and nurse adoption of an evidence-based guideline for acute pain management of hospitalized elders; 2) describe the relationship between organizational variables, and nurses’ and physicians’ adoption of EBPs for acute pain management; and 3) determine the cost-effectiveness ratios of the TRIP Toolkit intervention.  Rogers’ diffusion of innovation model guides this research. Study sites are eight acute care hospitals in the Midwest.  Sites will be stratified for size and then randomized to an experimental or comparison group.  Study units in these sites are those that receive acute admissions of non-critically ill adults, > 65 years of age, with hip fracture. Data will be collected from medical records (MRs) of patients >65 years of age, admitted with a diagnosis of hip fracture, as well as the nurses and physicians caring for these patients. MRs of patients will be abstracted for the 72-hour period following admission to the study unit. Dependent variables are nurse and physician adoption of EBPs for acute pain management, and the cost-effectiveness ratio of the TRIP Toolkit.  The GEE approach will be used to analyze all efficacy data.  Summative focus groups will be conducted after implementation of the TRIP Toolkit intervention, and these data will be analyzed using qualitative techniques.  Pain after hip fracture is a widespread problem and this research will promote use of evidence-based pain management practices to address this issue.