Pain management
paint a concerning picture for older adults living in care settings, where more than 28 per cent2
of residents are prescribed
one or more benzodiazepines. Given the associated risks, it is crucial for care teams to carefully consider alternative approaches to managing symptoms in this population. These can include non-pharmacological interventions which do not have side effects associated.
Traditional methods of assessing pain While there are many manual or paper- based pain assessment tools that carers can use, they are often underutilised due to the subjective nature of assessing pain for those who are unable to express their pain in a reliable way. This may result in care teams relying on their opinion or previous knowledge of a resident to gauge what level of pain they appear to be in.
Many manual pain assessment tools ask the assessor to rate the severity of certain indicators of pain, such as vocalisations, behavioural changes, and more. This introduces subjectivity, as assessors make these judgements based on their existing knowledge of the resident. While experienced carers who are familiar with a resident may be able to identify when they are in pain, those who are new or unfamiliar may struggle to detect the indicators associated with pain. Conversely, behaviours may be ‘normalised’ and not recognised if an assessor has had a long association with a resident. Beyond this, it can be a challenge to document, store and access previous pain scores conducted using paper-based methods. Prior to implementing digital pain assessment at Dovehaven, all our pain assessments were completed using the Numerical Rating Scale or the Abbey Pain Scale. They were only completed
by nurses or senior carers as part of risk assessment and care planning evaluation or review, meaning that care staff were not actively involved in the assessment and management of pain. Yet, it is well-known that care assistants working on the frontline delivering day-to-day care have a greater knowledge and understanding of residents and can identify nuances or changes in an individual more readily. The low number of pain assessments
carried out and inconsistency in their completion meant that there was no possibility of achieving ‘pain profiles’ for individual residents, which, in turn, reduces the effectiveness of proactive care management.
Digitising pain assessment Recognising these challenges and limitations of paper-based systems, we sought a digital alternative that could provide more objective insights. We also recognised that benzodiazepine usage was an issue that needed to be tackled and that the reason for their high usage was to manage resident distress. We wanted to
challenge the perception that distress is inevitable in people living with dementia, knowing that pain is often a significant driver of this distress and that there were alternative ways to treat it.
In a bid to tackle some of the issues
outlined above, last summer we implemented PainChek across all our care homes. This tool uses AI and the camera of a smart device to assess a resident’s face, while the carer observes the resident to assess their voice, movement, behaviour, activity, and body. The tool then calculates an overall pain score and stores the result. This outcome forms the evidence base supporting the implementation of pain management interventions, and for the ongoing monitoring of their effectiveness over time, empowering carers to detect pain in residents even when it is not obvious, quantify its severity, and monitor the impact of treatment to optimise care planning.
Initially, we faced some challenges in
maximising the utility of the tool, as, like with any new technology or piece of kit, familiarisation and openness to change is required. However, weekly refresher training webinars soon helped the care teams get up to speed and were incredibly helpful in upskilling staff at all levels, along with project management and oversight support. Ultimately, the key to success was in the reporting and communication of outcomes across the wider estate and having clear KPIs for care staff to work towards.
During the period of July to December
2024, Dovehaven completed over 165,000 pain assessments using this tool. This provided us with higher quality pain data, enabling us to optimise the care of residents, reduce the pain burden across
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www.thecarehomeenvironment.com July 2025
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