University of Chicago
Pragmatic Use of PAIN-Advanced Dementia Scale in Emergency Departments
Health Care Systems
University of Chicago
Dr. Hogan is an emergency physician and professor of medicine at the University of Chicago, concentrating in geriatric emergency medicine (GEM). Her research focuses on implementation of improved pain management for older adults, emergency regional anesthesia for hip fractures, and optimal emergency department (ED) care practices for people living with dementia. Dr. Hogan established The Geriatric Competencies for Emergency Medicine Residents and was a founding member of the American College of Emergency Physicians Board of Governors for Geriatric Emergency Department Accreditation that has accredited over 400 EDs in 45 states and six countries. She was also a founding member of the Geriatric Emergency Department Collaborative, the Society of Academic Emergency Medicine, and the Academy of GEM, national efforts supporting ongoing quality improvement and education in GEM. She is the Co-Editor-in-Chief of the Journal of Geriatric Emergency Medicine.
RATIONALE: Real-world emergency department (ED) pain assessment in people living with advanced dementia is notoriously poor or even absent, even though the PAIN-Advanced Dementia (PAINAD) tool has been validated in research settings. A clinical nudge to nurses through use of a computer decision support screen containing the PAINAD at the right time during patient care in the ED may prompt PAINAD assessments for patients unable to provide a numeric pain score.
OBJECTIVE: To demonstrate the feasibility of implementing standardized PAINAD assessments during the routine ED care of people with advanced dementia presenting with hip pain. Measurement of time to first analgesic administration and change in pain intensity for those receiving PAINAD scores will show improvements in ED pain care of those who receive PAINAD assessment.
SETTING: EDs at the University of Chicago and the University of North Carolina, Chapel Hill.
POPULATION: People with the preexisting diagnosis of advanced dementia who present to the ED with hip pain.
INTERVENTION: After brief education, a computer decision support screen containing the PAINAD scale will be presented to ED nurses during their intake assessment and again one hour after the administration of the first analgesic medication, with the goal of increasing PAINAD assessment and measuring its effect on analgesic administration and relief of pain intensity.
OUTCOMES: The primary clinical outcome is increased use of standardized PAINAD assessments during routine ED care.The secondary clinical outcomes are time to analgesic administration and change in pain score intensity. Implementation endpoints are the proportion of eligible patients receiving a PAINAD assessment and the number of assessments performed, time from pain assessment to administration of analgesic medication, and change in pain scores.
IMPACT: If successful, this pilot study will establish the feasibility of a large scale embedded pragmatic clinical trial testing the standardized PAINAD assessment essential in the appropriate pain management of people with advanced dementia. Advanced dementia significantly limits the ability of ED staff to assess pain, this intervention will provide a standardized tool to facilitate routine pain assessment and improve pain care in this population.