Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness-Implementation Study

OBJECTIVES: To evaluate the effectiveness and implementation of a multilevel pain management intervention in nursing homes (NHs) comprising a pain management guideline, care worker training, and pain champions.DESIGN: An implementation science pilot study using a quasi-experimental effectiveness-implementation (hybrid II) design.SETTING: Four NHs in Switzerland.PARTICIPANTS: All consenting long-term residents aged 65years and older with pain at baseline (N = 62) and all registered and licensed practical nurses (N = 61).INTERVENTION: Implementation of a contextually adapted pain management guideline, interactive training workshops for all care workers, and specifically trained pain champions.MEASUREMENTS: Interference from pain, worst and average pain intensity over the previous 24hours; proxy ratings of pain with the Pain Assessment in Advanced Dementia scale; and care workers' appraisal of the guideline's reach, acceptability, and adoption.RESULTS: Pain-related outcomes improved for self-reporting residents (n = 43) and residents with proxy rating (n = 19). Significant improvements of average pain from baseline to T1 (P = .006), and in worst pain from baseline to T1 (P = .003) and T2 (P = .004). No significant changes in interference from pain (P = .18). With regard to the implementation efforts, about 76% of care workers indicated they were familiar with the guideline; 70.4% agreed that the guideline is practical and matches their ideas of good pain assessment (75.9%) and treatment (79.7%).CONCLUSION: Implementation of a multilevel pain management intervention did significantly improve average and worst pain intensity in NH residents. However, to effect clinical meaningful changes in interference from pain, a more comprehensive approach involving other disciplines may be necessary.© 2019 The American Geriatrics Society.