Francesca Glamorgan at St Marys Villa Residential Aged Care

In 2019, the Commonwealth Department of Health funded a national rollout of PainChek® across residential aged care facilities (RACFs) in Australia.

Global advisory firm KPMG recently undertook an evaluation of the PainChek® rollout and found overwhelmingly positive outcomes for the Australian aged care sector.

As part of the evaluation, KPMG consulted with clinicians using PainChek® to capture their stories on how PainChek® was making a difference to their work and residents. Several case studies were identified demonstrating the powerful impacts of PainChek® on clinicians at the front line, residents under their care, and the broader aged care sector.

Case study #1: PainChek® was shown to instigate reduction in the use of psychotropic medication through identifying pain as a cause of challenging behaviour

A resident arrived at the facility following a hospital admission as a result of an injury. The resident exhibited agitated and aggressive behaviour, whereby facility staff felt that the resident was a risk to other residents. Due to the behaviours shown, a PainChek® assessment was undertaken. The assessment highlighted that the resident was experiencing severe pain.

Staff discussed this finding with the resident’s GP, who initially increased the resident’s psychotropic medication dose, as well as prescribing some analgesia. This resulted in the resident becoming extremely drowsy. The GP subsequently removed the analgesia; however, this resulted in the resident’s agitated behaviours returning. The GP then removed the psychotropic medication and focused on managing the resident’s pain. Staff reported that the resident was a “different person”, with a severe reduction in agitation.

Case study #2: PainChek® identified pain in residents that may not otherwise have been identified

A resident had a long history of complaining of generalised pain, accompanied by challenging behaviour. Historically staff had believed the pain to be psychosomatic and no treatment was provided to address or manage the resident’s concerns.

Following the implementation of PainChek® and a renewed focus on pain assessment and management, a PainChek® assessment was undertaken which showed moderate levels of pain.

Staff responded by providing PRN analgesia, which was effective in managing the resident’s pain and behaviour, with staff reporting that the resident was much less stressed and agitated.

Case study #3: PainChek® enabled accurate identification of changes in pain over time

A resident had a diagnosis of dementia and was resistant to taking oral medications. Staff noted an increase in behavioural incidents over a two-month period. A PainChek® assessment was completed, which identified moderate pain. As a result, an opioid patch was commenced for treatment, which significantly reduced behaviours for several months.

However, a recurrent increase in behavioural incidents over March occurred and, as per embedded protocols, a PainChek® assessment was undertaken and highlighted moderate pain levels. The prescriber was informed and increased the treatment dosage. This resulted in no further incidents from the resident.

Case study #5: PainChek® assessments shown to support non-medication related interventions

Staff at a RACF reported the objective nature of PainChek® enables better assessment and quantification of residents’ pain levels. In one example, a resident with severe dementia had a PainChek® assessment carried out which showed low levels of pain. Instead of using PRN medications to manage the resident’s pain, which often caused the resident to be drowsy, staff used a heat pack. It was reported this was effective and more beneficial to the resident’s quality of life.

Case study #6: A resident with heightened physical aggression was identified as having pain through a PainChek® assessment

A resident was showing episodes of aggression towards staff and other residents. The resident had been on paracetamol twice daily for osteoarthritis since admission. Since the implementation of PainChek®, the resident had been receiving pain assessments post behavioural incidents as part of the facility’s pain assessment protocol.

As an outcome, the patient had a change of prescription to a 5 mg buprenorphine patch. The change in medication resulted in a decrease of aggressive behaviour, restlessness and agitation.

Case study #7: PainChek® instigated a reduction in challenging behaviours through pain identification

A resident was exhibiting consistent calling out and wandering behaviour. All staff felt that it was “just him” as he had been doing this since admission. A PainChek® assessment was completed, which identified he had severe pain. Two paracetamol were given and PainChek® was completed again, and this time it provided a result of mild pain. The staff continued to complete PainChek® over the next two days and gave paracetamol where required.

They were then able to show this evidence to the GP, who then prescribed regular paracetamol. The behaviours ceased, and within one week the resident was able to engage with other residents and participate in the facility’s leisure and lifestyle program.

Case Study #8: Improved understanding of pain signs and symptoms as a result of using PainChek®

Prior to the rollout of PainChek®, one RACF found the most identifiable signs of pain came from guarding, refusal to walk, or pulling away which could all be recorded in the Abbey Pain Scale. Staff now note that they are more aware of facial expressions and how they indicate pain.

For example, a resident with cognitive impairment consistently scores mild to moderate pain levels following a PainChek® assessment. Staff have been spending more time with her noting facial expressions, such as grimaces, particularly following movement. Overall, this has enabled the facility to identify pain before it escalates to moderate to severe levels and has improved their pain management practices.

Case Study #9: PainChek® has improved the quality of life for residents with dementia

A resident was admitted to a RACF in January 2021. The resident was walking with an altered gait and would be teary at times. However, the next of kin were resistant to starting the patient on analgesic medication. As per the embedded pain management processes, a PainChek® assessment was undertaken during the admission process which highlighted moderate pain levels.

The patient was given paracetamol twice daily; however, teary episodes and altered gait continued. PainChek® scores were persistent at moderate levels. The paracetamol levels were increased to three times a day which has resulted in improved mood and uninhibited walking.


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