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Table 1 Observational pain management protocol

From: Implementation of observational pain management protocol to improve pain management for long-term institutionalized older care residents with dementia: study protocol for a cluster-randomized controlled trial

Process

Actions

1

Pain assessment

Using C-PAINAD for pain assessment

*2a

Score verification

Investigating possible causes of pain (such as injury or pain-related diagnosis), obtaining self-reports if at all possible by asking simple yes/no pain questions to participants, getting information from surrogates, direct contact nurses, and so on

3

Score interpretation

0-1 = no pain; 2-3 = mild pain; ≥ 4 = moderate pain or above

4

Pain-relieving interventions

Stage one (Pain score > 1):

Initiating pain-minimizing and caregiving guidelinesa

Stage two (Pain score > 4):

Non-pharmacological treatments: hot therapy, cold therapy, TENS, massage, and so on

- Consulting in-house physiotherapists, occupational therapists and nurses about the selection of treatment(s)

- Pharmacological treatments: analgesic trial

- Administering regular/‘if needed’ (PRN) analgesic medications 30 minutes before pain-triggered nursing procedures

- When no analgesic has been prescribed, discussing with resident’s physician whether or not to prescribe analgesics

5

Evaluation and continued monitoring

Monitoring the effectiveness of the implemented interventions by C-PAINAD

- Decreased pain score - continued monitoring

- If pain-related behavior persists - modify interventions

6

Documentation

All pain scores and pain treatments administered to participants must be recorded on the pain chart

2b

*Verification - no evidence indicates pain

- Attempting to interpret meaning of behavior with help of caregivers who are familiar with the residents

- Ensuring basic needs are met

  1. aPlease refer to Table 2 for detailed descriptions of the Pain-minimizing and Caregiving Guidelines.