Implementation of the Multidisciplinary Guideline on Chronic Pain in Vulnerable Nursing Home Residents to Improve Recognition and Treatment: A Qualitative Process Evaluation

Abstract

The recognition and treatment of pain in nursing home residents presents challenges best addressed by a multidisciplinary approach. This approach is also recommended in the applicable Dutch guideline; however, translating guidelines into practical strategies is often difficult in nursing homes. Nevertheless, a better understanding of guideline implementation is key to improving the quality of care. Here we describe and qualitatively evaluate the implementation process of the multidisciplinary guideline ‘Recognition and treatment of chronic pain in vulnerable elderly’ in a Dutch nursing home. The researchers used interviews and document analyses to study the nursing home’s implementation of the guideline. The project team of the nursing home first filled out an implementation matrix to formulate goals based on preferred knowledge, attitudes, and behaviors for the defined target groups. Together with experts and organizations, pharmacotherapy audit meetings were organized, an expert pain team was appointed, a policy document and policy flowchart were prepared, and ‘anchor personnel’ were assigned to disseminate knowledge amongst professionals. Implementation was partially successful and resulted in a functioning pain team, a pain policy, the selection of preferred measurement instruments, and pain becoming a fixed topic during multidisciplinary meetings. Nevertheless, relatively few professionals were aware of the implementation process.

Initiatives Targeting Health Care Professionals

“…KT-I programs met HCP needs with suitable resources and suggestions to practice 16,79 . Barriers to change were high staff turnover, limited administrative support, scheduling conflicts, heavy workload, and staff perceptions 86,88–91 …”

“…Over half (n = 10, 53%) of programs assessing adoption, reported increases in the use of program recommendations or resource use. The use of analgesics and nonpharmacological management strategies (eg, hot/cold therapy, transcutaneous electrical nerve stimulation, massage, and aromatherapy) promoted in KT-I programs showed inconsistent uptake after implementation 89,91–94 . Resources for families were considered in 1 LTC-directed program 70 .…”

“…However, high feasibility ratings did not guarantee patient outcome improvements 79,97 . Programs described as less feasible took time away from staff or used formats that lacked flexibility, such as written handouts for HCPs to read during shifts 89,91 …”

Initiatives Targeting Health Care Professionals

“…KT-I programs met HCP needs with suitable resources and suggestions to practice 16,79 . Barriers to change were high staff turnover, limited administrative support, scheduling conflicts, heavy workload, and staff perceptions 86,88–91 …”

“…Over half (n = 10, 53%) of programs assessing adoption, reported increases in the use of program recommendations or resource use. The use of analgesics and nonpharmacological management strategies (eg, hot/cold therapy, transcutaneous electrical nerve stimulation, massage, and aromatherapy) promoted in KT-I programs showed inconsistent uptake after implementation 89,91–94 . Resources for families were considered in 1 LTC-directed program 70 .…”

“…However, high feasibility ratings did not guarantee patient outcome improvements 79,97 . Programs described as less feasible took time away from staff or used formats that lacked flexibility, such as written handouts for HCPs to read during shifts 89,91 …”

Factors that influence the implementation of innovation in aged care: a scoping review

“…Of the 2530 retrieved studies, 193 were ultimately included 6,7,11–201 . The PRISMA-ScR diagram (Figure 1) shows the study selection process and reasons for full-text exclusion.…”

Observing and treating pain in people living with dementia in long-term care facilities

“…Additional systemic barriers may include limited training in pain assessment, lack of routine integration of pain scales into care workflows, insufficient organizational support, and the perception that observational tools are time-consuming or add limited value ( 21 , 24 , 29 , 30 ). Addressing these barriers likely requires organizational-level interventions, such as embedding pain assessment tools into electronic care records, aligning assessments with routine care moments, and reinforcing their importance through leadership and education ( 31 ).…”

Initiatives Targeting Health Care Professionals

“…KT-I programs met HCP needs with suitable resources and suggestions to practice 16,79 . Barriers to change were high staff turnover, limited administrative support, scheduling conflicts, heavy workload, and staff perceptions 86,88–91 …”

“…Over half (n = 10, 53%) of programs assessing adoption, reported increases in the use of program recommendations or resource use. The use of analgesics and nonpharmacological management strategies (eg, hot/cold therapy, transcutaneous electrical nerve stimulation, massage, and aromatherapy) promoted in KT-I programs showed inconsistent uptake after implementation 89,91–94 . Resources for families were considered in 1 LTC-directed program 70 .…”

“…However, high feasibility ratings did not guarantee patient outcome improvements 79,97 . Programs described as less feasible took time away from staff or used formats that lacked flexibility, such as written handouts for HCPs to read during shifts 89,91 …”

Factors that influence the implementation of innovation in aged care: a scoping review

“…Of the 2530 retrieved studies, 193 were ultimately included 6,7,11–201 . The PRISMA-ScR diagram (Figure 1) shows the study selection process and reasons for full-text exclusion.…”

Observing and treating pain in people living with dementia in long-term care facilities

“…Additional systemic barriers may include limited training in pain assessment, lack of routine integration of pain scales into care workflows, insufficient organizational support, and the perception that observational tools are time-consuming or add limited value ( 21 , 24 , 29 , 30 ). Addressing these barriers likely requires organizational-level interventions, such as embedding pain assessment tools into electronic care records, aligning assessments with routine care moments, and reinforcing their importance through leadership and education ( 31 ).…”

Initiatives Targeting Health Care Professionals

“…KT-I programs met HCP needs with suitable resources and suggestions to practice 16,79 . Barriers to change were high staff turnover, limited administrative support, scheduling conflicts, heavy workload, and staff perceptions 86,88–91 …”

“…Over half (n = 10, 53%) of programs assessing adoption, reported increases in the use of program recommendations or resource use. The use of analgesics and nonpharmacological management strategies (eg, hot/cold therapy, transcutaneous electrical nerve stimulation, massage, and aromatherapy) promoted in KT-I programs showed inconsistent uptake after implementation 89,91–94 . Resources for families were considered in 1 LTC-directed program 70 .…”

“…However, high feasibility ratings did not guarantee patient outcome improvements 79,97 . Programs described as less feasible took time away from staff or used formats that lacked flexibility, such as written handouts for HCPs to read during shifts 89,91 …”

Factors that influence the implementation of innovation in aged care: a scoping review

“…Of the 2530 retrieved studies, 193 were ultimately included 6,7,11–201 . The PRISMA-ScR diagram (Figure 1) shows the study selection process and reasons for full-text exclusion.…”

Observing and treating pain in people living with dementia in long-term care facilities

“…Additional systemic barriers may include limited training in pain assessment, lack of routine integration of pain scales into care workflows, insufficient organizational support, and the perception that observational tools are time-consuming or add limited value ( 21 , 24 , 29 , 30 ). Addressing these barriers likely requires organizational-level interventions, such as embedding pain assessment tools into electronic care records, aligning assessments with routine care moments, and reinforcing their importance through leadership and education ( 31 ).…”