Registed Nurses' Association of Ontario

Evidence Booster: Best Practice Guideline Implementation to Reduce Pain

The purpose of this guideline is to provide evidence-based recommendations for nurses and other members of the interprofessional team who are assessing and managing people with the presence, or risk of, any type of pain.

One in five Canadians have moderate to severe persistent (chronic) pain, and have a lower quality of life compared to other chronic diseases. Chronic pain costs Canadians over $6 billion a year in direct health care which is more than the cost of HIV, cancer, and heart disease combined. The productivity costs due to sick time and job loss amount to $37 billion per year for Canada.

Practice Changes

The Home Care BPSO implemented the BPG across the  organization and revised how client care assessments are conducted. Nurses conduct initial pain assessments which include standardized screening for pain. This helps to identify clients who need a pain management care plan. If pain is identified on admission, then an individualized  pain management care plan is developed and implemented and monitored by the interprofessional team, to support better pain control.

Since 2016, this Ontario LTC BPSO has undertaken several practice changes that include: pain assessment completed within 24 hours of admission, comfort care rounding implemented throughout the home, and hourly screening of residents for pain. The Pain Assessment IN Advanced Dementia (PAINAD) tool replaced the Abbey Pain Assessment Scale and now all LTC home staff use the PAINAD tool which is also integrated into the BPSO's documentation system. To bridge any communication gaps, a pamphlet was developed for residents and family regarding pain management. Education has improved communication  amongst the interprofessional team and increased uptake of the practice changes.