Timing in the communication of pain among nursing home residents, nursing staff, and clinicians

Background: The management of nursing home (NH) residents' pain requires adequate nursing assessment and clinician knowledge of pain therapies. However, the timely communication of pain from residents to nurses and from nurses to clinicians is equally necessary. Using a 4-step model (nursing assessment of pain, notification of clinicians regarding pain assessment, clinicians' assessment of pain and intervention), and nursing reassessment following an intervention, we describe the timing with which each of these steps occur. Methods: In a telephone survey of directors of nursing from 63 of the 68 nursing homes in New Haven County, Connecticut, we determined (1) how often nurses assess pain in residents, (2) when nurses notify clinicians about residents' pain, (3) how often clinicians assess pain, and (4) when nurses reassess pain after a clinician's intervention. Results: Whereas in 76% of NHs nurses assessed pain in residents without pain at least "quarterly", only in 46% of NHs was pain assessed in residents with pain at least "every shift." In 42% of NHs nurses notified clinicians at least when the regimen was "ineffective." Only 55% of directors of nursing reported that clinicians assessed pain at least every 30 to 60 days. Finally, in 73% of NHs nursing reassessment occurred at least 1 hour after intervention. Conclusions: There is considerable variability in how frequently nurses and clinicians assess pain, when clinicians are notified about pain, and how frequently nurses reassess pain. Studies are needed to determine optimal timing in the communication process of pain to allow better pain management outcomes and quality of care for NH residents.