Abstract
Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.
Highlights
Despite its high prevalence in long-term care (LTC; [1]), pain is often undertreated in such facilities, in part due to many patients’ limited ability to communicate pain because of the cognitive and linguistic impairments that accompany dementia [2, 3]
This research represents possibly the most important step in a program of research that began with the development of effective clinically useful approaches to assessing pain in nursing home residents with dementia (e.g., [36, 43]), continued with the demonstration that regular pain assessments lead to benefits for both residents and staff [8, 15], proceeded with the development of pain assessment/management guidelines designed to take resource realities into account [22], demonstrated that these guidelines are deemed important by frontline clinicians [24], and, in this investigation, examined the feasibility of actual implementation protocol in accordance with principles of implementation science literature [29]
With our innovative use of a Pain Champion who was already employed in a leadership role within the facility, we address this limitation while still being able to respond to the fiscal realities of the LTC facilities
Summary
Despite its high prevalence in long-term care (LTC; [1]), pain is often undertreated in such facilities, in part due to many patients’ limited ability to communicate pain because of the cognitive and linguistic impairments that accompany dementia [2, 3]. Systematic pain assessment (see [11,12,13,14] for review) and pain management protocols have been found to be effective for residents with dementia. Regular pain assessments in LTC have been shown to improve pain management practices and reduce unnecessary polypharmacy, which is beneficial for the work satisfaction of nursing staff (e.g., [7, 15,16,17,18]). Feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability
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