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 Overcoming Obstacles to Effective Pain Management

Staff Education                                                                                                                         The Staff Education department can play an essential role in assuring the success of the facility’s pain care program. Learning needs assessments can be done not just on staff members, but also residents and family. Staff can be educated about pain care policies and procedures through orientation and inservices. Information gained from the Quality Assurance department will pinpoint what areas need to be covered in inservices throughout the year. Staff education should include activities for all the facility departments: Nursing, Social Services, Activities, Dietary, and Restorative Nursing. 

Employees need to be educated in geriatric pain needs such as their atypical presentation of pain and paradoxical responses to pain medication. The facility policy and procedure on pain management can outline the rationale for interventions. Regular inservices on the facility pain care program and use of new pain assessment and measurement tools will assist staff to understand and comply with the facility’s program. Staff education can help to correct misconceptions, myths, and biases about pain and pain management. Training should include the use of standardized pain scales, recognizing and assessing pain, and pain management methods. 

Identifying Pain                                                                                                                                                  Current models of pain management programs define pain as whatever the resident reports it to be. NHQI’s overview of pain states that the most accurate evidence of pain and its intensity is based on the resident’s self report. Facility assessment and monitoring forms will need to reflect this type of pain measurement.

Cognitive and Communication Deficits                                                                                     It is estimated that as many as 50% of long term care residents have cognitive and/or communication deficits, and may be unable to directly communicate their needs. Staff will need to be trained in assessing and monitoring pain in these residents with tools specific to the purpose. 

Fear of Administering Pain Medications                                                                                                 Lack of a comprehensive pain care plan for each resident in pain leaves uncertainty in staff about how often it is appropriate to administer pain medications. Having a clear outline of interventions that involve the entire health care team facilitates confidence in applying interventions. Staff education in pain care management can help to overcome misconceptions and increase understanding of the distinctions between addiction, dependence, tolerance, and appropriate pain treatment. 

Continuity of Care                                                                                                                                                   The high turnover rate of nursing staff in facilities can present an obstacle to continuity of care. Having a key administrative person to oversee the pain program can help to maintain compliance with the pain program. A Pain Care Committee that meets at least monthly and assesses the facility’s program is a key to successful pain management.

The Quality Assurance department should monitor and track staff compliance with the program and the success of measures implemented.

Inservices on Pain Care can include covering such topics as:

Pain care policy and procedure 

Statistics on pain in the elderly 

Standards and clinical guidelines of pain management 

The Enhanced Quality Measure for Pain 

MDS and RAP documentation for pain 

Review of the forms for the pain program 

Documentation guidelines 

Pain scales 

Special pain care needs of the cognitively impaired 

Non-pharmacological interventions 

Side effects of pain medication 

The Resident Pain Care Bill of Rights 

Care-planning pain

 More information on pain management can be found in the book:

Special Care Topics for Long Term Care, Vol. I

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