Evaluation of a pain assessment and management quality improvement initiative in long term care facilities

Croucher, Danita (2022) Evaluation of a pain assessment and management quality improvement initiative in long term care facilities. Practicum Report. Memorial University of Newfoundland. (Unpublished)

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Abstract

Background: In response to pain prevalence rates of more than double the national benchmark, Eastern Health implemented an initiative in 2018 to improve the quality of pain assessment and management among residents of its long term care (LTC) facilities. The initiative introduced standardized pain assessment tools to front-line Registered Nurses and Licensed Practical Nurses. A preliminary documentation audit, in 2019, showed that the use of these tools is limited. Purpose: This evaluation was developed to determine if there has been a change in the utilization rates of the standardized pain assessment tools since the past audit, while also exploring the challenges and barriers to the use of such tools throughout Eastern Health Long Term Care (EHLTC). Methods: A review of resident charts was conducted at four EHLTC facilities in St. John’s, NL to determine if pain assessment was completed as per organizational policy. Data were compared to that of a past audit to determine if there was a significant change in the utilization rates of the assessment tools. An online questionnaire was designed to identify challenges and barriers to the use of the tools, from the perspectives of frontline staff, as well as suggestions on how to improve their uptake. Results: A total of 39 charts were reviewed. Descriptive statistics and chi-square tests were used to analyze the data. Results showed no significant differences in the use of the pain assessment tools since the past audit. Rates of pain assessment among residents between 2019 and 2022 remained low. Seven questionnaire responses were received. Thematic analysis was used to examine the responses. Common barriers to the use of pain assessment tools were poor attitudes and inadequate staff knowledge, documentation difficulties, time constraints, and staff resources/staff turnover. Suggestions to increase the use of the assessment tools included education, improved staff ratios/staff consistency, and the involvement of Resident Care Coordinators (RCCs) in pain assessment. Conclusion: Questionnaire results provided insight into the barriers of the use of pain assessment tools in EHLTC, allowing for the proposal of recommendations to enhance the overall effectiveness of the initiative.

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