Pain assessment in long term care facilities using a tablet app version of the PACSLAC-II
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Pain is highly prevalent in the aging population, especially among older adults residing in long-term care (LTC) facilities. In this population, and especially among residents living with cognitive impairments, pain is often underassessed and undertreated. Cognitive impairments, such as those associated with dementia, lead to more challenging pain assessments due to communication barriers between the assessor (e.g., nurse) and the LTC resident. The Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) scales are validated observational pain assessment checklists that are used to identify pain in older adults with cognitive impairments. Use of the PACSLAC scales has been successful in distinguishing pain-related from non-pain related behaviours. When used regularly, the PACSLAC scales not only reduce pain levels for LTC residents, but nursing staff also report reduced stress and burnout levels. Such scales, however, are not utilized as often as recommended, likely related-in part-to the extra paperwork and record-keeping that is involved with the paper-and-pencil administration of these scales. This study, therefore, compared the implementation of a newly-developed tablet app version of the PACSLAC-II to a paper-and-pencil version of the PACSLAC-II with respect to compliance with administration guidelines (e.g., frequency of pain assessments). A case series research design was employed across independent LTC units in conjunction with staff training and an implementation program that involved a nurse champion who encouraged and oversaw use of the PACSLAC-II. The study was carried out for a total of six weeks. LTC units were randomized to use either the tablet app, paper-and-pencil, or both versions of the PACSLAC-II in accordance with the implementation protocol. During the implementation, pain assessment frequencies were gathered using quality indicator measurements. Interview and questionnaire data were collected to examine front-line staff (i.e., nurses, care aides) stress and burnout levels during the baseline and implementation periods. The quality indicator results revealed no notable difference in pain assessment frequency between tablet app and the paper-and-pencil version of the PACSLAC-II. Nonetheless, analysis of the interviews suggests that nursing staff preferred the tablet app version over the paper-and-pencil version of the PACSLAC-II. Front line staff stress levels and burnout levels did not appear to differ across administration conditions, although a small sample size of staff members prevented a statistical comparison. This study is part of a larger investigation. Next steps and future directions for research are addressed in the discussion.