Assessing and managing pain in aged care can present nurses and carers with substantial challenges. Not only in ensuring a person has their pain effectively controlled, but also in having the right documentation to demonstrate this process to regulators and family members.
The needs of a person in aged care can vary massively across a single home or organisation. However, a foundational step is to identify a person’s ability to reliably verbalise their pain.
Identifying a person’s ability to self-report pain
Generally, a person will fall into one of three categories;
-They have the ability to reliably self-report pain.
-They do not have the ability to reliably report pain.
-Or they fluctuate between the two states depending on their health (presence of delirium, for example).
Selecting the right pain management assessment tool may depend on where the service users fit within the above categories. However, with the increased prevalence of dementia in aged care (driven by the tripling of people living with dementia by 2050), the proportion of residents in aged care who cannot reliably self-report their pain is going to increase. This stresses the importance of a reliable tool to identify the presence of pain where it may not be obvious, and also quantify that pain to allow for better pain management.
There are a number of paper-based assessment tools to do this, however, they remain underutilised and hampered by unintentional assessor bias. This calls for a quick, easy, and objective assessment process, ensuring accurate point of care assessment and effective pain management.
Effective pain management assessment tools in aged care
As outlined by the Social Care Institute for Excellence (SCIE), people living with dementia are at an increased risk of experiencing pain. Not only can this be attributed to a decline in the ability to reliably self-report pain; people living with dementia are also vulnerable to other physical risks, such as falls, skin tears or other painful comorbidity issues such as osteoarthritis.
In order to provide person-centric care to all, the SCIE guidelines suggest starting with asking the resident about their pain. This is always the best assessment method if that person retains the ability to effectively communicate. In addition to this, ensuring carers have in depth knowledge about the people in their care will support more informed and targeted pain management decisions. This includes keeping thorough and up-to-date records within a person’s care plan (PainChek offers a number of integrations into widely used care planning systems) outlining any known existing conditions such as:
-Arthritis
-Pressure sores
-Ulcers
-Recent injuries
-History of constipation
-Dental issues
In addition to knowing the presence of any existing conditions, also having a strong understanding of a person’s usual mood and mental wellbeing can be useful in identifying pain when it may not be obvious.
Once these first two steps are complete, the SCIE advice then recommends the use of a validated tool to assess pain. Historically, these have generally been paper-based assessment forms. There are multiple options to choose from, all having their own benefits, but equally their own limitations.
Whilst paper-based assessments are widely available, their effective use is still limited. The nature of many assessment methods is subjective, often asking assessors to allocate a numeric value to various domains of pain. This means the assessor has to assess the severity of pain through their own judgement, which often differs between people. This means pain scores often vary between assessors, ultimately meaning the pain may also be managed differently. This is also fueled by a relatively low level of training on identifying pain in advanced dementia across the sector. Symptoms of pain can also be commonly mistaken for Behavioural and Psychological Symptoms of Dementia (BPSD), meaning the pain is never identified and therefore treated. This stresses the importance of an objective, reliable, point-of-care pain assessment tool.
PainChekⓇ Universal assessment tool
PainChekⓇ is the world’s first regulatory cleared medical device for the assessment of pain. Now including the Numeric Rating Scale (NRS), PainChek® meets the needs of all aged care residents, regardless of their ability to reliably self-report pain. As the SCIE advice outlines, self-reporting pain (using a system like the NRS) is the best method, providing that person has the ability to report pain reliably, which is facilitated within the PainChek® solution. PainChek®’s AI, facial analysis and smartphone technology intelligently automates the pain assessment process to identify and quantify pain in those who cannot reliably self-report. This tool, as the SCIE recommends, is clinically validated. By having the two functionalities within the one point-of-care solution, it also meets the needs of those who can fluctuate between the two states.
