Worsening pain | HQCA Focus

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Long Term Care

Worsening pain

Percentage of residents whose pain worsened in terms of intensity and frequency between assessments. (see data definition)

Data source: Alberta Health Services, Analytics. “All 35 QIs by province/zone/facility”. (2024). [Dashboards showing RAI quality indicators, by province, zone, and site, by quarter]. AHS Tableau Reporting Platform.

What do you think?

  • Looking at these results over time, are there any trends?
  • Looking at these results over time and between zones, are there differences?
  • After selecting a facility, are the site results changing over time? How do the most recent quarter results compare to the provincial and zone results?
  • When comparing sites with similarities like zone, setting (e.g., urban or rural), operator type (e.g., private), and size, how are the results different? What factors could account for these differences?

Understanding "worsening pain"

Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (International Association for the Study of Pain, 1979).  There are many types of pain, including:

  • Acute pain – pain of recent onset and short duration that is usually due to injury or disease;
  • Chronic pain – pain that lasts or recurs for longer than 3-6 months, also known as persistent pain;
  • Transitional pain – pain that transitions from acute to chronic;
  • Cancer-related pain – a common complication of cancer that may be a result of the disease itself or due to treatment; or
  • Pain related to a palliative illness, condition, or disease (Alberta Pain Strategy, 2019).

The experience of pain is unique to each person, and involves multiple dimensions, including physical, psychological, social, emotional, and spiritual and is frequently modified by contextual factors. The complexity of pain often makes it difficult for clients and providers, within long term care and other areas of the healthcare system, to work together to assess and manage pain.

Pain can go unrecognized in older adults, more often in persons living with dementia.

This measure does not include residents who do not experience pain at their follow-up assessment, either because there is an absence of pain or their pain management protocol was successful.

Considerations when viewing the results:

When thinking about this quality indicator, providers and leaders can consider a number of things to better understand and improve these results. To ensure alignment across areas of the healthcare system with respect to pain management, it is important to understand the Alberta Pain Strategy. Once familiar with this document, some questions they could ask before taking action include:

  • What protocols are in place to help residents and staff recognize and communicate pain?
  • What barriers exist to identifying pain (e.g., cognitive impairment)? What tools exist to help identify and proactively manage pain (e.g., routine pain assessment)? What strategies or approaches can help to overcome barriers and leverage tools for pain identification and management?
  • How are active (e.g., exercise, repositioning, stretching and breathing techniques, meditation, application of heat) and passive (e.g., medication, acupuncture) pain management strategies understood by staff? How can staff empower residents to embrace active pain management strategies?
  • How can loved ones support pain identification and management strategies?

Alberta Quality Matrix for Health

The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. This measure can be used as input to assess long term care’s performance in these dimensions of quality: Acceptability, Appropriateness, and Effectiveness.