Barriers to optimal pain management in aged care facilities: an Australian qualitative study

Up to 80% of residents in aged care facilities (ACFs) experience pain, which is often suboptimally managed. To characterize pain management in ACFs and identify the barriers to optimal pain management. An exploratory descriptive qualitative study using semistructured interviews. Five Southern Tasmania, Australian ACFs. 23 staff members (18 nurses and 5 facility managers). Interviews were conducted from September to November 2015. Interviews included questions about how pain was measured or assessed, what happened if pain was identified, barriers to pain management, and potential ways to overcome these barriers. Interviewees noted that there were no formal requirements regarding pain assessment at the ACFs reviewed; however, pain was often informally assessed. Staff noted the importance of adequate pain management for the residents’ quality of life and employed both nonpharmacologic and pharmacologic techniques to reduce pain when identified. The barriers to optimal pain management included difficulty identifying and assessing pain, residents’ resistance to reporting pain and/or taking medications, and communication barriers between the nursing staff and GPs. Staff interviewed were dedicated to managing residents’ pain effectively; however, actions in a number of areas could improve resident outcomes. These include a more consistent approach to documenting pain in residents’ progress notes and improving nurse-GP communications to ensure that new or escalating pain is identified and expedient changes can be made to the resident’s management. Additionally, resident, family, nurse, and carer education, conducted within the facilities on a regular basis, could help improve the pain management of residents.