View My Goals

Explore Goal

Deciding what you want to change and communicating that intention is the first step of the quality improvement cycle. This page provides a general description of the goal and its benefits to share with your team.

Pain management means that long-term care communities will implement a comprehensive system to address issues related to pain. This system involves assessing and managing pain in residents, both long and short term, so that all residents have individualized, person-centered care plans. Long-term care residents will receive appropriate care to prevent and minimize episodes of moderate to severe pain. Less than adequate pain management can affect residents’ daily activities and quality of life. It can also cause depression, sleeplessness, restlessness, or decline in appetite and unintentional weight loss.

  • How Does Pain Management Benefit Residents?

    Residents can express their wishes for pain management.

    Residents do not experience a decline in functional status due to uncontrolled pain.

    Residents are not at risk for depression due to uncontrolled pain.

    Residents do not experience a decline in quality of life due to unmanaged pain.

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  • How Does Pain Management Benefit Long-term Care Staff?

    Staff members are more likely to experience enhanced job satisfaction.

    Staff will have tools and resources to address the various aspects of pain management to enhance quality of care.

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  • How Does Pain Management Benefit Long-term Care Communities?

    Communities have satisfied residents and families, which translates into better care and image in the community.

    Providers have improved quality measures due to improved resident care and satisfaction results.

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Step 2 – Tracking Tool  >

Tracking Tool

The Campaign Tracking Tools allow you to document your work, monitor outcomes and the processes related to your outcomes. To achieve a data-driven quality improvement project, collect data for several months to establish a solid baseline and set a target for your improvement; then continue collecting data -- charts within the workbooks and trend graphs on the website provide you and your team with the feedback you need to determine if the changes you are making are being fully implemented and if they are having the expected impact on your outcomes. Keep your workbook up-to-date on a daily or weekly basis and look at data often to support a rapid cycle quality improvement project. Download the data tracking tool and collect data for a month or so to determine your starting point.

Questions? Contact the NNHQI Campaign Help Desk:

Before you start, read our Tip Sheet on Testing Change & Starting Small (PDF).

Step 3 – Examine Process  >

Examine Process

This set of probing questions will help you evaluate your current processes and provide guidance for ways to make improvements.

  • Why is our pain prevalence rate high?

    • Has there been a change in the prevalence of pain?
    • What is driving our high pain rate?
    • What is the percentage of individuals with severe pain -- those with intensity score 7-10?
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  • Which groups are most affected? Are they:

    • Long stay or short stay?
    • Rehabilitation residents?
    • Individuals on the same unit?
    • On a dementia unit?
    • Being treated for pain?
    • Receiving palliative care?
    • Receiving pharmacological interventions for pain?
    • Receiving pain medications on a routine pain schedule?
    • Receiving pain medications on a PRN basis?
    • Using non-pharmacological interventions?
    • Receiving relief from the interventions?
    • Expressing verbal complaints about their pain?
    • Suffering from a terminal illness or at the end-of-life?
    • Expressing nonverbal signs of pain?
    • Individuals seeking drugs?
    • Being cared for by the same provider/prescriber?
    • Being cared for by the same caregiver(s)?
    • Refusing medications?
    • Individuals whose families are making decisions about pain medications?
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  • Processes and Resources to Consider

  • What types of assessments are we using?

    • Are assessments done daily?
    • Are we capturing signs of pain staff observe in individuals?
    • Are we listening to the resident’s report of pain?
    • What type of assessment tool are we using?
    • Do we use a dementia-specific assessment tool?
    • Are we using a verbal scale?
    • Are we using a non-verbal scale?
    • Do we match the right assessment with the population?
    • Do we use nursing home pain management protocols or standing orders for pain management?
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  • Are we treating the pain?

    • Are there standing orders for pain medications? Are they being given?
    • Are we proactive in treating pain?
    • What additional interventions can we consider?
    • Have we considered using both pharmacological and non-pharmacological interventions?
    • Do we have a timely pain assessment and treatment process for an acute pain crisis -- a pain intensity score greater than 7?
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  • Are we evaluating our performance?

    • Are follow-up assessments occurring?
    • How do we know our interventions are effective?
    • Have we considered adding additional interventions?
    • Have we considered consulting with a pain specialist for intractable pain?
    • Do we recognize sentinel events as they relate to pain assessment and management?
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  • What are we doing to educate our staff?

    • Is staff educated with the assessment tools?
    • Is staff educated on the nonverbal signs and symptoms of pain?
    • Are we empowering individuals and their families by educating them about effective short and long-term pain management?
    • Are we concerned about residents becoming addicted to medications when they are on hospice care or the near end-of-life?
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Step 4 – Create Improvement  >

Create Improvement

The Science of Change

  • The Circle of Success is a quality improvement framework and a guide to finding the resources you need on the website.
  • Quality Improvement Methods are evidence-based approaches for creating systemic change. This collection includes quick-start instructions, templates, and mini-videos.
Evidence-Based Practices
Pain Management Education
Website Resources for providers, residents and their families, and staff.
Adobe PDF This presentation provides an overview of the key concepts of pain assessment and pain management with the goal of improving health outcomes for nursing home residents.
Improved Pain Management in Nursing Homes
Assessing Pain
Website Tools for assessing pain in residents who are able to self report.
Website Tools for assessing pain in residents with dementia or other cognitive impairment with a limited ability to communicate.
Managing Pain
Adobe PDF New  Guide to Evidence-based NonPharmacologic Interventions for Pain
Website Comprehensive resources for both pharmacologic and non-pharmacologic interventions.
Adobe PDF Pharmacological Management of Persistent Pain in Older Adults: Special Article in the Journal of the American Geriatrics Society.

Step 5 – Engage  >


Engaging stakeholders creates a robust and successful quality improvement project. Use these fact sheets to start the conversation and encourage everyone to be involved. A story board is a wonderful, visual way to engage your community in the project, keep everyone in the know about new changes that are being tested, and share your challenges and successes along the way.

Story Board Guide
Adobe PDF Storyboard guide from QAPI
Use this guide to create a compelling poster to keep your community engaged in your project, monitor your progress, and celebrate your success. Print outcome trend graphs from your Campaign account to document your change!
Pain Fact Sheets
Adobe PDF Leadership Fact Sheet
Adobe PDF Staff Fact Sheet
Adobe PDF Consumer Fact Sheet

Step 6 – Monitor & Sustain  >

Monitor & Sustain

Once you make a change or an improvement, it’s important that you continue to collect and submit your data to ensure your improvements are working.

Step 7 – Celebrate Success  >

Celebrate Success

Too often we let accomplishments pass by without notice because we are already moving on to the next step. But, it's important to take a moment to celebrate accomplishments, big and small.

A celebration program can create a spirit of community in your nursing home. Use visible awards such as certificates, plaques and other tangible rewards that can be proudly displayed. Try giving a spontaneous award from time to time to acknowledge people who are going the extra mile.

More resources on their way. Please check back soon.

Back to Goals  >

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