• Sharon Kaasalainen, Kevin Brazil, Noori Akhtar-Danesh, Esther Coker, Jenny Ploeg, Faith Donald, Ruth Martin-Misener, Alba DiCenso, Thomas Hadjistavropoulos, Lisa Dolovich, and Alexandra Papaioannou.
• School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada. kaasal@mcmaster.ca
• J Am Med Dir Assoc. 2012 Sep 1; 13 (7): 664.e1-8.

ObjectivesTo evaluate the effectiveness of (1) dissemination strategies to improve clinical practice behaviors (eg, frequency and documentation of pain assessments, use of pain medication) among health care team members, and (2) the implementation of the pain protocol in reducing pain in long term care (LTC) residents.DesignA controlled before-after design was used to evaluate the effectiveness of the pain protocol, whereas qualitative interviews and focus groups were used to obtain additional context-driven data.SettingFour LTC facilities in southern Ontario, Canada; 2 for the intervention group and 2 for the control group.ParticipantsData were collected from 200 LTC residents; 99 for the intervention and 101 for the control group.InterventionImplementation of a pain protocol using a multifaceted approach, including a site working group or Pain Team, pain education and skills training, and other quality improvement activities.MeasurementsResident pain was measured using 3 assessment tools: the Pain Assessment Checklist for Seniors with Limited Ability to Communicate, the Pain Assessment in the Communicatively Impaired Elderly, and the Present Pain Intensity Scale. Clinical practice behaviors were measured using a number of process indicators; for example, use of pain assessment tools, documentation about pain management, and use of pain medications. A semistructured interview guide was used to collect qualitative data via focus groups and interviews.ResultsPain increased significantly more for the control group than the intervention group over the 1-year intervention period. There were significantly more positive changes over the intervention period in the intervention group compared with the control group for the following indicators: the use of a standardized pain assessment tool and completed admission/initial pain assessment. Qualitative findings highlight the importance of reminding staff to think about pain as a priority in caring for residents and to be mindful of it during daily activities. Using onsite champions, in this case advanced practice nurses and a Pain Team, were key to successfully implementing the pain protocol.ConclusionsThese study findings indicate that the implementation of a pain protocol intervention improved the way pain was managed and provided pain relief for LTC residents.Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

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