What if a resident’s pain chart comes back negative?
Aged care facilities frequently rely on personal care workers to identify pain behaviour to do their pain charts and then subsequently have a Registered Nurse complete the evaluation and assessment. Often facilities are finding that the pain charts are coming back negative, despite an identified clinical need by the Registered Nurse/Medical Officer/Physiotherapist, because of:
- asking a resident with a cognitive deficit about pain at rest is not effective (they may not remember until they move)
- some people do not identify with the word ‘pain’ but may call it another term like their ‘ache’, their ‘arthritis’, or their ‘catch’ etc
- an inability to identify the non-verbal indicators of pain (grimacing, guarding, jumping on moving a joint etc)
In order to substantiate the requirement for a pain assessment for pain management directives, two strategies have proven effective at a number of facilities:
1. A physiotherapist completing a pain assessment summary and using this as the substantiating documentation in the appraisal pack. A physiotherapy core skill is the assessment and management of musculoskeletal pain, and this summary evaluates pain:
- Major symptoms
- History
- Behaviour (aggravating and easing factors, irritability)
- 24 hour picture
- Relevant diagnoses
- Cognitive impairment effect
- Referral (medication/MO review)
2. Having a physiotherapy assessment completed, then the physiotherapist advising on the behaviour of the problem, and re-completing the pain chart. Needs to include:
- The area (so the PCW can ask/observe about specific body parts)
- The aggravating factor (so the PCW knows when to look for it, e.g. sore knee on weight bearing and not in sitting during med round)
- The non-verbal signs that may accompany aggravation for that particular resident
- Any words that might be specific to the resident’s pain
Wellness & Lifestyles is currently servicing over 50 aged care facilities in South Australia for ACFI specific physiotherapy using this strategy.
