Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Dr. Candace Harrington PhD, DNP, MSN, BSN, APRN, AGPCNP-BC, CNE

Committee Member

Dr. Hines-Martin PhD, PMHCNS, RN, FAAN

Author's Keywords

Comprehensive pain assessment, chronic pain, rapid cycle quality improvement


Background Literature supports the need for comprehensive pain assessment (CPA) in long-term care facilities. CPAs provide valuable information for facility providers and health care staff to intervene appropriately regardless of cognitive ability. Without the use of such tools, pain can go undertreated or ignored for this underserved population causing undue suffering and poor quality of life. Chronic pain perpetuates an endless cycle of immobility, falls, injury, functional decline, and eventual death for this population.

Purpose: A CPA was implemented, evaluated, and integrated into the care processes in a long-term care facility for veterans

Method: The IHI improvement model with a 2-cycle plan, do study and act (PDSA) process was used to implement a CPA care process in a long-term care facility for veterans. Demographic data were collected, and chart audit data were analyzed using Excel. Charting compliance was used for the first cycle because the baseline compliance was zero. The percentage of change was calculated for the second cycle.

Results: For cycle 1, compliance for the pain assessment was 5.14%. Following the first cycle, compliance was 70.2% for all elements. Compliance after cycle two improved to 78.7%., which did not quite meet the 80% benchmark set but showed dramatic improvement from baseline. The total positive change of 13% over this 8-week quality improvement project exceeded the 10% improvement benchmark for a positive percentage of change.

Implications: Proper evaluation of the resident’s chronic pain improved the quality of care and provided a replicable process for other long-term care facilities.

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