Having the time to do the assessment expectations/wishes related to comfort accurately level Lack of knowledge/experience with pain Have a process in place to provide assessment consistency in timing of assessments. Lack of appreciation for the importance of First thing in morning and after therapy pain assessment not effective; be aware of possible Not taking time to understand the sundowning effect for some underlying causes of pain; taking time to residents/patients in late understand the patient/resident history, afternoon/evening. diagnoses Pain scales laminated and placed in Taking time to know the resident/patient resident/patient and on med carts Taking time to know what the Initial and on-going education for staff on resident/patient wants as far as comfort how to effectively conduct an assessment level and the importance of a good pain Timing of assessment is important. assessment. Have clear processes in place and accessible to staff for conducting assessments. Have processes in place to reinforce education and conduct observations of the application of practices to check for drift in behavior and provide real-time staff coaching Recognize staff effectively implementing key practices Assessment Tool Design: Add note in MDS about the discrepancy Assessment Tool Design: MDS assessment tool is not telling of how of average pain vs. brief momentary pain the overall pain. Question working tends Ideally - reword the MDS to say, “What to capture momentary and brief pain would you say your pain has been on rather than average/overall pain making average……” appropriate pain management more challenging. What is the worst pain you have had in the last 5 days? If the resident says it is “10”, recorded and this is not reflective of their average pain. Dementia Difficult to assess pain in Have process in to gather patients/residents with cognitive resident/patient diagnosis, history, family impairments perceptions; identify life losses, comfort May not be able to express in that habits, etc. they have pain, where it is located, and the Have a process in place to gather intensity information and perceptions from CNAs Participants have found the Pain Assessment in Advanced Dementia
Having the time to do the assessment accurately Lack of knowledge/experience with pain assessment Lack of appreciation for the importance of pain assessment Not taking time to understand the underlying causes of pain; taking time to understand the patient/resident history, diagnoses Taking time to know the resident/patient Taking time to know what the resident/patient wants as far as comfort level Timing of assessment is important. Assessment Tool Design: MDS assessment tool is not telling of how the overall pain. Question working tends to capture momentary and brief pain rather than average/overall pain making appropriate pain management more challenging. What is the worst pain you have had in the last 5 days? If the resident says “10”, it is recorded and this is not reflective of their average pain. expectations/wishes related to comfort level Have a process in place to provide consistency in timing of assessments. First thing in morning and after therapy not effective; be aware of possible sundowning effect for some residents/patients in late afternoon/evening. Pain scales laminated and placed in resident/patient and on med carts Initial and on-going education for staff on how to effectively conduct an assessment and the importance of a good pain assessment. Have clear processes in place and accessible to staff for conducting assessments. Have processes in place to reinforce education and conduct observations of the application of practices to check for drift in behavior and provide real-time staff coaching Recognize staff effectively implementing key practices Assessment Tool Design: Add note in MDS about the discrepancy of average pain vs. brief momentary pain Ideally - reword the MDS to say, “What would you say your pain has been on average……” Dementia Difficult to assess pain in patients/residents with cognitive impairments May not be able to express in that they have pain, where it is located, and the intensity Have process in to gather resident/patient diagnosis, history, family perceptions; identify life losses, comfort habits, etc. Have a process in place to gather information and perceptions from CNAs Participants have found the Pain Assessment in Advanced Dementia
Pain_Assessment-Management_Discussion_Summary.docx