[Pain management in patients with cognitive impairment: a research implementation project]

People with cognitive impairment and consecutive communication disturbance are, due to their illness, a very vulnerable group of patients. They are particularly at risk that their pain is not well assessed and therefore often not treated adequately. Insufficient pain management however impacts health status and decreases cognitive functioning and the patients' quality of life. The aim of the evidence-based practice development project was to establish a systematic pain management for cognitively impaired patients on a surgical ward of a regional hospital. Based on a literature review a quality standard and an algorithm including the pain assessment instrument BESD were developed and subsequently implemented. The project was evaluated by obtaining data from the patients charts and by interviewing the nurses. Ten patients were included in the project. First results showed that pain was individually assessed with the patients in each shift and that pain was treated both with and without medication. Nurses paid more attention to pain assessment and improved their practice of structured assessments in patients with severe cognitive impairment. We therefore recommend applying both the standard and the pain assessment instrument BESD with cognitively impaired patients.