Pain Assessment Policies and Management in Long-Term Care
Policies are Needed to Ensure Better Pain Assessment Policies and Management in Long-Term Care
Despite a very high prevalence of pain in long-term care, most Canadian jurisdictions only mandate pain assessment on admission and every three months thereafter. These mandated assessments are part of a much larger evaluation of each resident based on the Resident Assessment Instrument-Minimum Data Set (RAI-MDS). Although some facilities and nurses may evaluate pain more frequently, the minimum standard (i.e., assess every three months) set by policy is not sufficient. Pain problems are often missed in long-term care residents with dementia because these residents may not be able to verbally express their pain due to cognitive and language impairments. Moreover, although there are valid observational tools to assess pain in people with severe dementia (e.g., the Pain Assessment Checklist for Seniors with Limited Ability to Communicate) these tools are not used widely in conjunction with RAI-MDS or other pain assessments. As such, assessments are often based on subjective nurse opinion and pain problems may be missed. According to a group of geriatric pain and public policy experts, policy change should mandate that each resident be assessed for pain, using a standardized and validated tool, at minimum once a week (and more often if pain is suspected). Evidence shows that more frequent pain assessment improves pain management and reduces stress levels for staff. Basic pain assessments can usually be completed within 5 minutes (with patients who have findings of moderate to severe pain requiring more thorough investigations). Our team has demonstrated that weekly pain assessments can be accommodated in many long-term care facilities with existing resources.
How You Can Help? Would you like to share your thoughts on our See Pain More Clearly initiative and the use of social media to mobilize knowledge about pain in dementia?
We are looking for policymakers to participate in a study to evaluate the effectiveness of the #SeePainMoreClearly social media initiative to mobilize knowledge about pain in dementia.