This second instalment in the PainChek Blueprint series explores how care providers can make medication optimisation practical, consistent and sustainable by embedding objective pain assessment into everyday care.
Medication has a vital role in residential and nursing care. Used well, it improves comfort, supports independence, reduces health deterioration and helps residents remain safely in the home. But every medication decision depends on the quality of the evidence behind it: whether pain is present, how severe it is, what may be causing it and whether the response is working.
For residents living with dementia, cognitive impairment or communication difficulties, pain is often hidden. It may appear as agitation, withdrawal, disturbed sleep, reduced mobility, resistance to care or escalating distress. Without a consistent pain assessment method, care teams can be left interpreting behaviour rather than evidencing the cause.
PainChek changes that. As a clinically validated, regulatory-cleared digital medical device, it helps trained care staff detect, score and monitor pain at the point of care. The result is a clearer evidence base for safer PRN use, more effective medication reviews and more person-centred care planning.
The new PainChek in-app dashboard strengthens this further by bringing an organisation’s pain management policy into the workflow. For carers, it helps prioritise assessments, guide interventions and reassess outcomes throughout the day. For providers, it creates a more consistent, auditable approach to pain management, improving care outcomes while reducing clinical and compliance risk.
Why pain must come first in medication optimisation
Medication optimisation is not simply about reducing or increasing medication. It is about using the right medicine, at the right time, for the right reason, with clear evidence of impact.
Pain is a common hidden driver of distress and deterioration. If it is missed, teams may treat the behaviour rather than the cause, leading to unnecessary escalation, delayed analgesia, inappropriate PRN use or medication reviews that lack the evidence clinicians need.
Traditional tools can struggle in practice because they are often time-consuming, paper-based, inconsistently completed or restricted to senior and clinical staff. As a result, pain assessment can become episodic rather than embedded into daily care.
PainChek closes that gap. Because it is fast, digital, objective and simple enough for trained care staff to use, assessments can happen when they matter most: before medication, after medication, during changes in presentation and across daily routines.
Practical Blueprint: PainChek and PRN/variable-dose medicines
PRN and variable-dose medicines depend on timely evidence: why the medicine is being considered, whether pain is present, what action was taken and whether it worked. PainChek is uniquely suited to this workflow because it can be completed in under two minutes, compared with around 7.5 minutes for the Abbey Pain Scale, making pre- and post-medication assessment realistic in busy care homes.
Its value is not speed alone. PainChek combines AI-supported facial analysis with a structured assessment, giving teams a more consistent and objective view of pain than observation alone. Because trained carers can use it at the point of care, evidence is captured closer to the resident, not delayed until a senior or clinician is available.
This makes PainChek simple and practical to embed into PRN protocols. It supports clearer documentation of non-verbal cues, pain scores, actions taken and reassessment outcomes. It also helps teams spot patterns, challenge assumptions and show whether PRN medication, including end-of-life opioids, has delivered the intended benefit.
A simple five step PRN workflow:
- Spot the trigger: pain behaviours, distress, movement-related discomfort, sleep change, reduced mobility or end-of-life symptoms.
- Assess first: complete PainChek before giving PRN medication to evidence pain presence and severity.
- Check the protocol: confirm indication, dose range, maximum daily dose, minimum interval, alternatives and review triggers.
- Act and document: record the reason, dose, time, non-medicine interventions and resident presentation.
- Reassess: repeat PainChek after the expected onset time and escalate if pain persists, worsens or PRN use becomes frequent.
The Care Quality Commission updated its PRN medicines guidance last year. Documented pain assessments such as PainChek can help support the protocols set out in the new guidance, ultimately leading to fewer hospital transfers for care home residents. Read more in our blog here.
Practical Blueprint: PainChek before psychotropic medication
Psychotropic medicines have a place when clinically needed, but they must be used carefully. For some residents, they can contribute to sedation, confusion, falls risk, reduced mobility and further deterioration. PainChek gives teams a safer first step: assess pain before medication becomes the default response to distress.
When a resident is agitated, calling out, resisting care or pacing, the first question should not be “what can we give?” It should be “could this be pain?” PainChek helps teams answer that quickly and objectively. If pain is present, treat the pain. If pain is not indicated, explore other causes such as constipation, infection, hunger, thirst, boredom, loneliness, environmental triggers or the need for activity and fresh air.
This is where PainChek’s design matters. Tools that rely heavily on interpretation, or are used mainly by senior teams, cannot create the same real-time evidence base. PainChek helps the whole home move from assumption to evidence in the moment of care.
A simple five step psychotropic review workflow:
- Recognise distress: agitation, calling out, resistance to care, pacing, withdrawal or sleep disturbance.
- Pause before PRN psychotropics: complete PainChek to check whether pain may be driving the distress.
- Treat pain if indicated: follow the agreed pain plan, using medicine and non-medicine interventions as appropriate.
- Look wider if pain is not indicated: investigate physical, emotional, social and environmental causes of distress.
- Share the evidence: document the assessment, action and outcome, then use patterns to inform reviews with nurses, GPs, pharmacists and wider healthcare teams.
For residents on regular psychotropics, PainChek can also be used proactively across the day to build a clearer picture of pain peaks, triggers and response patterns. For example, several care home clients – who wished to take a more proactive approach to pain management – instructed its team to conduct four pain assessments per day on a select group of high-risk residents. Over time, the data and evidence collected can support reviews of whether psychotropic medication remains necessary, whether doses can be reduced, or whether pain management should be adjusted instead.
The evidence reinforces the value of assessing pain first:
- 10% reduction in antipsychotic use across Orchard Care Homes’ estate.
- 20% reduction in benzodiazepine and antipsychotic prescribing in an 18-month PainChek case study.
- 33% reduction in antipsychotic use and 25% reduction in analgesics in a Scottish Care Inspectorate pilot.
- 58% reduction in benzodiazepine use across Dovehaven Care Homes, with regular benzodiazepines reducing from 14% to 6% and PRN benzodiazepines from 9% to 3% over six months across more than 20 care homes.
The practical message is simple: assess pain first, treat the true cause and use the evidence to support safer medication decisions.
From better pain assessment to stronger operational outcomes
Medication optimisation is not only a clinical priority. It also affects falls, hospital transfers, staff workload, resident stability, family confidence and occupancy. Daniel Casson’s report, The Immediate Financial Impact of Using PainChek, links consistent PainChek use with improved care quality, reduced deterioration and stronger financial resilience.
Reported findings included:
- Up to 48% fewer falls
- 50% fewer hospital admissions
- 59% fewer ambulance call-outs
- 64% fewer resident discharges due to unmet care needs
- Potential turnover uplift of up to 2% through fewer avoidable discharges and more proactive care
These outcomes depend on consistent use. PainChek is not a tool for occasional review, escalation or senior-only assessment. It is designed to be embedded into everyday care, giving teams the evidence they need before problems become crises.
In the short term, PainChek supports better decisions at the point of care. In the medium term, it builds patterns that strengthen medication reviews. In the long term, it helps providers create a more proactive model of care: less guesswork, earlier intervention, safer prescribing and fewer avoidable escalations.
For care providers, the message is clear: sustainable medication optimisation starts with sustainable pain assessment.
Building a sustainable blueprint for medication optimisation
A stronger medication optimisation model needs four things: consistent observation, objective assessment, clear documentation and confident communication between carers, nurses, GPs, pharmacists, families and wider healthcare teams.
PainChek is built for that reality. It is quick enough to use before and after medication, objective enough to reduce guesswork, simple enough for trained care staff to adopt and robust enough to inform clinical review. That combination allows PainChek to embed sustainably across whole homes, not just sit alongside existing processes.
For providers, the opportunity is clear: make pain visible earlier, use medication more confidently, reduce avoidable deterioration and strengthen resilience across the home.
Discover the findings from Daniel Casson’s report, The Immediate Financial Impact of Using PainChek, and learn how PainChek can support proactive care, safer medication optimisation and stronger financial resilience.
