Researchers have explored many methods for improving pain management in institutionalized care settings, including pain education programs, quality improvement initiatives, and clinical decision-making algorithms that provide a standardized approach with step-by-step instructions.

Guidelines of the Agency for Healthcare Research and Quality, the American Pain Society, and The Joint Commission consistently advocate for a formalized approach to pain management, assessment, and frequent reassessment/monitoring.3

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Despite their demonstrated utility, standardized protocols for pain assessment are not widely implemented in institutional settings.

“The gap in this area is not availability of assessment tools, but rather, how best to implement and sustain their use in these settings,” Andrea Gilmore-Bykovskyi, PhD, RN from the University of Wisconsin-Madison School of Nursing told Clinical Pain Advisor.

Common issues include high turnover rates, lack of organizational resources for adopting and maintaining new practices, and a stringent regulatory environment that may discourage innovation,

“Additional research is needed to improve our understanding of the barriers to adoption of these tools, as well as to develop systematic approaches to implementing and sustaining their use in long-term care settings,” Dr. Gilmore-Bykovskyi pointed out, noting that policy initiatives supporting program integration may also be beneficial.

“Evidence suggests that clinical decision-support programs [such as PRT] are likely superior to education alone. Future research is needed to explore their [comparative] efficacy on a range of outcomes relevant to patients with cognitive impairment, including pain and challenging symptoms such as agitation,” Dr. Gilmore-Bykovskyi concluded.

The study was supported by the National Science Council of Taiwan.

The authors report no conflicts of interest.

References

1. Chen YH, Lin LC. Ability of the Pain Recognition and Treatment (PRT) Protocol to Reduce Expressions of Pain among Institutionalized Residents with Dementia: A Cluster Randomized Controlled Trial. Pain Manag Nurs. 2015 Nov 12. pii:S1524-9042(15)00154-X. doi: 10.1016/j.pmn.2015.08.003. [Epub ahead of print]

2. Herman AD, Johnson TM 2nd, Ritchie CS, Parmelee PA. Pain management interventions in the nursing home: a structured review of the literature. J Am Geriatr Soc. 2009 Jul;57(7):1258-67. doi: 10.1111/j.1532-5415.2009.02315.x. Epub 2009 Jun 3. Review.

3. Buffum MD, Hutt E, Chang VT, Craine MH, Snow AL. Cognitive impairment and pain management: review of issues and challenges. J Rehabil Res Dev.2007;44(2):315-30. Review. PubMed PMID: 17551882.