Implementing a pain management program in a long-term care facility using a quality improvement approach

Area of Science:

• Gerontology
• Pain Management
• Quality Improvement in Healthcare

Background:

• Pain is a significant challenge in skilled nursing facilities (SNF) and nursing homes (NH).
• Many facilities lack uniform pain assessment and treatment plans, despite evidence showing scales improve detection and management.
• This study aimed to analyze baseline pain levels and implement a standardized pain scale in an institutionalized elderly population.

Purpose of the Study:

• To analyze baseline pain levels in institutionalized elderly patients.
• To implement and evaluate a standardized pain scale for pain assessment and management.
• To identify challenges associated with adopting standardized pain assessment methods.

Main Methods:

• A Quality Improvement (QI) project involving 40 randomly selected patients from skilled care and dementia units.
• Chart review to document pain syndromes, medications, and use of pain evaluation tools.
• Introduction and staff training on verbal and nonverbal pain scales, followed by baseline pain evaluation using the PDSA model.

Main Results:

• 84.2% of the study population were females, with a mean age of 91.4 years.
• 50% of patients experienced mild to moderate pain; some regimens had toxicity potential (e.g., excessive acetaminophen).
• Nursing staff successfully adopted the pain tools, providing positive feedback on their utility for prompt pain identification and treatment.

Conclusions:

• Pain evaluation and management are crucial due to high prevalence and negative impacts on quality of life and survival.
• Standardized verbal and nonverbal pain evaluation tools are essential in NH and SNF settings.
• Regular cognitive and behavioral assessments, alongside standardized orders, can enhance pain management and reduce analgesic toxicity.