3.5 Pain Assessment and Pain Control

A structured program for routine pain assessment is a key element in effective pain management (Ferrell, 1995). In the last several years, the NFQR survey has been designed to more closely examine pain assessment and pain control for residents in nursing facilities. Two key elements of successful pain assessment are to (1) use a validated pain assessment tool and (2) consistently use the same appropriate tool for each resident.

Use of Pain Assessment Tools

NACES interviewers reviewed medical charts to determine if validated pain assessment tools were being used. Interviewers found that nursing facilities used both observational and self-reported assessment tools. Observational assessment tools included either the Pain Assessment in Advanced Dementia (PAINAD) Scale or the Assessment of Discomfort in Dementia (ADD) Protocol. Self-reported pain assessment tools included the Wong-Baker Faces Pain Scale, Pain Thermometer, Verbal Description Tool, or a Numeric 0-10 Rating Scale.

Survey results indicate that a validated assessment tool was used to assess pain in 70% of nursing facility residents. Results also indicate that validated assessment tools were used more often in 2008 compared to 2004, 2005, and 2006 (8):

2004 — 56%
2005 — 59%
2006 — 40%
2007 — 71%
2008 — 70%

Consistent Use of Pain Assessment Tools

Using an appropriate tool consistently is important because repeated use of the same tool each time an individual is assessed for pain increases the reliability of the assessment.

Survey results indicate that a validated assessment tool - observational or self-reported - was used consistently in 64% of all pain assessments done in nursing facilities (Figure 3.5). Consistent use of validated tools to assess pain was significantly higher in 2008 than in 2004, 2005, and 2006 (9):

2004 — 42%
2005 — 39%
2006 — 35%
2007 — 64%
2008 — 64%

Reliable Pain Assessment Results

Interviewers used the Wong-Baker tool to measure residents’ current level of pain. Sixty-five percent of residents reported no pain. Significantly more residents reported moderate to worst pain in 2008 than in 2004 or 2005 (10).

2004 — 7%
2005 — 7%
2006 — 9%
2007 — 10%
2008 — 10%

Pain Control

In 2008, 65% of residents in nursing facilities who reported being in moderate to worst pain also reported being satisfied with their treatment for pain (Figure 3.5):

2004 — 64%
2005 — 55%
2006 — 63%
2007 — 60%
2008 — 65%

Frequency of pain assessment

In 2008, a new question regarding frequency of pain assessment was added to the NFQR survey. Results indicate that 54% of all residents in nursing facilities who reported moderate to worst pain were assessed for pain every shift. Twenty-one percent of residents were assessed for pain before pain medications were administered and seven percent were assessed after pain medications were administered:

Every shift — 54%
Every day — 4%
Once a week — 4%
Once a month — 9%
Before pain medications — 21%
After pain medications — 7%

Ideally, 100% of residents should be assessed for pain both before and after pain medications are administered.

Figure 3.5 – Pain Assessment and Control

What was the resident’s level of pain on the Wong-Baker Faces Pain Scale [Q5.1]?

No pain — 65%
Mild pain — 10%
Moderate pain — 7%
Severe pain — 2%
Very severe pain — 0.5%
Worst pain — 0.5%
Unable to determine — 15%

Reliability of pain assessment [Q5.3 and 5.4] and [Q5.5 and 5.6]

Was a validated pain assessment tool used consistently with a specific resident?

Yes — 64%
No assessment tool used — 36%

Of residents in moderate to worse pain (10%) [Q5.1 and 5.7]

Was the resident satisfied with the level of pain relief in the last 24 hours?

Yes — 65%
No — 35%

Survey conducted: February – July 2008 [Q#.#] = Survey question number (Appendix A) Survey sample: 2,129 from 128,971 residents (Medicare, Medicaid, or any other payer source) living in the 1,044 Medicaid certified nursing facilities in Texas. For further information, contact the NFQR Project Lead at 512-438-3472

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Footnotes

8. Statistically significant at p<.01.

9. Statistically significant at p<.01.

10. Statistically significant at p<.01

Updated: June 8, 2010