Evaluating Effects of the PAINAD Scale on Pain Management in Patients With Dementia

Nurse leaders at our site identified a gap in evidence-based practice related to dementia-specific pain assessment. The purpose of this quality improvement project was to improve pain detection and management in patients with advanced dementia by implementing the observational Pain Assessment in Advanced Dementia (PAINAD) scale in the clinical electronic medical record.

Our project team used a pre- poststudy design to evaluate practice changes in implementing the PAINAD scale. Nurses were notified of the change to documentation through hospital-wide newsletters, daily huddles, and unit managers.

Data was retroactively collected through chart review of patients with advanced dementia for the four weeks prior to implementation, and at 4- and 6-weeks after the implementation. Data collected included documentation of an observational pain assessment, treatment (pharmacologic or nonpharmacologic), whether pain was present, use of psychotropic medications, and documented improvement in pain at reassessment. We also surveyed nurses to understand their perceptions of the PAINAD.

Improvements were observed in rates of observational pain assessment, analgesic or nonpharmacologic treatment of pain, and avoidance of psychotropic medications at 6-weeks post-implementation. However, no improvement was observed in the proportion of patients with reduced pain at reassessment after treatment. No changes were statistically significant. Overall, nurses were comfortable using the PAINAD and perceived it as useful.

Implementing the PAINAD scale appeared to improve observational pain assessments and pain treatment at our facility.

Implementation of the PAINAD scale across all clinical care units and expanded staff education are necessary to improve pain outcomes for patients with advanced dementia.