Research ArticleResearchMedication Safety

Among older surgical patients with a new gabapentinoid prescription, 38% had prolonged use after skilled nursing

Journal of the American Geriatrics Society (PubMed)Jul 11, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In Medicare data for 79,417 older surgical patients discharged through skilled nursing before going home, 4% received a new gabapentinoid prescription and 38% of those new users had prolonged use.

What NurseJet pulled from the source

Researchers linked Medicare hospital, outpatient, clinician, and Part D data from 2013 through 2020 to examine gabapentinoid use after 14 common operations in adults aged 66 or older who moved from the hospital to a skilled nursing facility and then home. Among 79,417 patients, the median skilled-nursing stay was 15 days. A total of 3,182 patients (4%) received a new gabapentinoid prescription, and 1,219 of those new users (38%) met the study definition of prolonged use. Female sex, gabapentinoid days' supply, emergency surgery, nonorthopedic and nonvascular surgery, and greater area deprivation were associated with prolonged use in adjusted analysis. The authors found that prolonged use was more common than previously reported among patients discharged directly home and called for more work on medication continuation after skilled-nursing discharge. The claims-based design did not determine whether an individual patient's prolonged use was clinically appropriate.

Why this matters for nurses

A medication started around surgery can follow a patient across hospital, skilled-nursing, and home settings, making its original purpose and intended duration easy to lose. This study matters for nurses because medication reconciliation and clear handoff documentation can make a new gabapentinoid visible for review at each transition.

Bedside takeaway

Be aware that 38% of the older surgical patients newly prescribed a gabapentinoid during a hospital-to-skilled-nursing-to-home transition had prolonged use, a persistence signal that warrants reconciliation without assuming inappropriateness.

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Key takeaways

The cohort included 79,417 Medicare patients aged 66 or older who underwent one of 14 operations and transitioned through skilled nursing before returning home.
New gabapentinoid use occurred in 3,182 patients, or 4% of the full cohort.
Among those newly prescribed a gabapentinoid, 1,219 patients, or 38%, had prolonged use.
The study describes prescribing persistence and associated factors but does not establish that prolonged use was inappropriate.

Practice implications

During medication reconciliation, nurses can clarify and document when a gabapentinoid was started, its current indication, and whether continued use remains intended, then route uncertainty through the prescriber or pharmacist. The study does not support labeling every prolonged prescription inappropriate or independently stopping a patient's medication.

Limitations & cautions

This retrospective claims analysis used 2013 to 2020 Medicare data and cannot establish why a prescription continued or whether continued use was appropriate. It may not generalize to younger patients or newer prescribing patterns, and associations with prolonged use do not establish that the identified factors caused it.
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Citations

Exact source links

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Journal of the American Geriatrics Society (PubMed)

Journal of the American Geriatrics Society (PubMed). Prolonged Use of Postoperative Gabapentin After Discharge From a Skilled Nursing Facility.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42435316/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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BMC Palliative Care (PubMed)Jul 11, 2026Research Article

In a cluster-randomized study of 10 nursing homes and 119 residents who died, a 40-hour palliative-care course for staff was associated with a greater likelihood that a documented pain event had a subsequent measure recorded.

Geriatrics LeadershipAI summaryReview source

Research ArticleResearchQuality ImprovementAI summary · original source linked below

This cluster-randomized study tested whether a 40-hour multiprofessional palliative-care course for nursing-home staff changed care documented during residents' last three months of life. Five of 10 German nursing homes received the training. Records were analyzed for 119 residents who died during follow-up: 42 in intervention homes and 77 in control homes. Specialized outpatient palliative care was documented for 19.0% of residents in the intervention group and 9.1% in the control group. Pain was documented for 57.1% versus 49.4%, respectively. Across 225 recorded pain events, a subsequent measure was documented in 73.6% of intervention-group events and 61.9% of control-group events; multilevel analysis found higher odds of a follow-up measure after training (OR 1.804). The authors concluded that staff qualification may improve recognition and response, while noting the challenges of inconsistent real-world documentation. The study primarily measured recorded processes rather than resident comfort or symptom relief.

Key takeaways

The cluster-randomized study included 10 nursing homes, with staff at five facilities completing a 40-hour palliative-care course.
Records from 119 residents who died were reviewed for palliative symptoms and measures during the final three months of life.
A subsequent measure was recorded after 73.6% of documented pain events in intervention homes versus 61.9% in control homes.
In multilevel analysis, the odds of a documented follow-up measure after a pain event were higher in the intervention group (OR 1.804).

Why this matters on shift

Palliative needs can be missed when staff lack a shared framework for recognizing symptoms and responding consistently. This study matters for geriatric nurses and educators because it links structured training with a measurable change in documented follow-up after pain events near the end of life.

Bedside takeaway

Worth knowing that after nursing-home staff completed a 40-hour palliative course, documented pain events were more likely to have a follow-up measure recorded, although the study did not establish better resident comfort.

Nursing implications

For long-term-care teams, the findings support reviewing whether palliative education connects symptom recognition to a documented response within the facility's care plan and escalation process. Better documentation is useful, but it should not be treated as proof that pain improved or that one course format fits every facility.

Limitations & cautions

Only 10 facilities and 119 deceased residents were included, with unequal resident counts between groups. Outcomes came from records and focused mainly on documentation and care processes; the abstract reports no confidence interval for the adjusted odds ratio and no direct resident comfort, pain-severity, or family outcome.
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Citations · exact source links

BMC Palliative Care (PubMed). Better palliative care for residents of inpatient nursing homes through qualification of nursing staff - a cluster randomised study.

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International Emergency Nursing (PubMed)Jun 29, 2026Systematic Review

A network meta-analysis of 24 randomized trials involving 8,014 adults with difficult IV access found that ultrasound guidance improved first-attempt and overall cannulation success versus standard practice, while local warming showed narrower benefits supported by less evidence.

Emergency Med-SurgAI summaryReview source

Systematic ReviewResearchWorkflowNew Grad FriendlyAI summary · original source linked below

Difficult intravenous access can lead to repeated attempts, treatment delays, pain, and added cost. This systematic review searched four databases through February 1, 2026 and used a network meta-analysis to compare 11 active interventions across 24 randomized trials with 8,014 adults. Compared with standard practice, ultrasound guidance improved first-attempt success (OR 5.58, 95% CI 2.74 to 11.36) and was the only intervention with a significant overall-success benefit (OR 4.12, 95% CI 2.07 to 8.19). Local warming also improved first-attempt success and reduced procedure time and pain, but rested on more limited evidence. Near-infrared devices reduced attempts and improved satisfaction, while long catheters were associated with more pain and longer procedures. The authors judged ultrasound the most consistently supported option but cautioned that a sparse evidence network and assumptions behind indirect comparisons temper certainty.

Key takeaways

The network meta-analysis included 24 randomized controlled trials, 8,014 adults, and 11 difficult-access interventions.
Ultrasound guidance improved both first-attempt and overall cannulation success compared with standard practice.
Local warming improved first-attempt success and reduced procedure time and pain, but its evidence base was more limited.
The sparse comparison network and its transitivity assumption limit certainty about intervention rankings.

Why this matters on shift

Obtaining vascular access is a frequent nursing task, and repeated failed attempts can delay treatment while increasing pain. This review matters for emergency and med-surg nurses because it compares common escalation options in one analysis and separates the most consistently supported approach from promising but less certain alternatives.

Bedside takeaway

Worth knowing that across 24 randomized trials, ultrasound guidance had the most consistent evidence for first-attempt and overall success in adults with difficult IV access, while local warming showed narrower benefits with less evidence.

Nursing implications

For nurses following an approved difficult-access pathway, the findings support timely escalation to an ultrasound-trained clinician when standard attempts are unlikely to succeed and consideration of local warming where protocol permits. The rankings should not replace patient assessment, local competency requirements, or the unit's vascular-access policy.

Limitations & cautions

The analysis combined trials of 11 interventions through direct and indirect comparisons, so rankings depend on the assumption that studies were sufficiently comparable. The network was sparse, evidence for some options was limited, and the abstract does not provide certainty ratings or enough setting detail to establish one universal pathway.
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Citations · exact source links

International Emergency Nursing (PubMed). Comparative effectiveness of interventions for difficult intravenous access in adults: A systematic review and network meta-analysis of randomized controlled trials.

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Annals of Work Exposures and Health (PubMed)Jun 3, 2026Research Article

In a randomized study of 42 medical and nursing students, N95 instruction improved knowledge and quantitative fit, video and guided training retained better fit than text at 3 months, and standardized exertion reduced fit.

Leadership Med-SurgAI summaryReview source

Research ArticleResearchInfection ControlNew Grad FriendlyAI summary · original source linked below

This prospective study randomized 42 medical and nursing students with little prior N95 experience to text-based, video-based, or person-guided training. Knowledge-question accuracy rose from 46.0% at baseline to 65.9% immediately after training, then declined to 59.2% at 2 weeks and 54.9% at 3 months; knowledge results did not differ significantly among training groups. Median quantitative fit factor increased from 28 before training to 143.5 immediately afterward and remained above baseline at 130 after 2 weeks and 126 after 3 months. At 3 months, fit remained significantly better with video or guided instruction than with text alone (P=0.029). During treadmill walking at 1.5 and 3 miles per hour, fit factor declined as respiratory and heart rates increased. The authors concluded that training effects fade, video or guided formats better preserve fit performance, and exertion may compromise fit. The trial did not measure workplace exposure or infection.

Key takeaways

The randomized study included 42 medical and nursing students assigned to text, video, or person-guided N95 training.
Median fit factor rose from 28 before training to 143.5 immediately after training, then measured 126 at 3 months.
Video and guided instruction retained better quantitative fit than text instruction at 3 months, while knowledge did not differ by group.
Quantitative fit declined during standardized walking as respiratory and heart rates increased.

Why this matters on shift

Passing instruction once does not guarantee that N95 knowledge or fit performance will remain stable during later clinical work. This study matters for infection-prevention nurses and educators because it measures both retention over three months and the effect of movement, not only immediate post-training knowledge.

Bedside takeaway

Be aware that video and guided N95 instruction preserved quantitative fit better than text alone at 3 months in 42 students, while fit declined during exertion; this supports reinforcement but does not define a refresher schedule.

Nursing implications

For respiratory-protection programs, the findings support hands-on or video-supported instruction, objective fit testing, and reinforcement rather than relying on text alone. The study does not define an ideal refresher interval or replace institutional fit-testing requirements, manufacturer instructions, or reassessment when respirator fit may have changed.

Limitations & cautions

The trial included only 42 medical and nursing students, most without prior formal respirator training, so results may not generalize to experienced clinicians. Follow-up lasted three months, exertion was standardized on a treadmill, and the study measured knowledge and fit factors rather than workplace exposure or infection outcomes.
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Citations · exact source links

Annals of Work Exposures and Health (PubMed). Temporal effects of educational interventions on fit and knowledge retention of N95 filtering facepiece respirator under rest and exertion.

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Key takeaways

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Limitations & cautions

Exact source links

More updates for this clinical area

A 40-hour palliative-care course was linked to more follow-up action after documented pain in 10 nursing homes

Ultrasound guidance had the strongest overall evidence for difficult IV access across 24 randomized trials

Video or guided N95 training preserved quantitative fit better than text alone at 3 months in a 42-student trial