3836 Improving the use of painad on geriatric wards—an agonising challenge

Abstract Introduction Pain is a major concern in cognitively impaired patients. Communication challenges contribute to poor recognition and undertreatment, negatively impacting prognosis and quality of life. The National Dementia Audit highlighted that structured pain assessment for people with dementia admitted to hospitals remains a significant area for improvement. The PAINAD (Pain Assessment in Advanced Dementia) scale aids in structured pain recognition through objective assessment. We implemented a quality improvement project aiming to improve PAINAD utilisation in inpatient geriatric wards. Methods Using the ‘Plan-Do-Study-Act’ (PDSA) approach, baseline data was collected from inpatient wards at two large teaching hospitals: Queen’s Medical Centre (QMC), Nottingham and Royal Derby Hospital (RDH), where PAINAD is recommended by local trust guidelines. Frequency of PAINAD use in patients with dementia and/or delirium was observed. Based on gaps identified, the first cycle intervention was board-round discussions to improve awareness around pain recognition and identify high-risk patients and opportunities for PAINAD utilisation. In the second cycle, bite-sized teaching for ward staff was conducted across both sites, and posters highlighting use of PAINAD displayed on the wards. Results Baseline data of 60 patients showed inconsistent pain assessment documentation; neither site used PAINAD routinely, prompting the first cycle of action. 42 opportunities for PAINAD utilisation were identified in board-round meetings over 5 days. PAINAD was completed in 14% of these opportunities. In some instances, the score was actioned with appropriate analgesia. Use of PAINAD remained inconsistent across both sites, prompting the second PDSA cycle, for which data collection is ongoing. Conclusion PAINAD utilisation remained suboptimal despite efforts to highlight the importance of recognising pain in inpatients with dementia. With consistent use, PAINAD could enable robust assessment and pain management in these patients. Future interventions to be considered include prompts on electronic prescription systems to encourage pain assessment in targeted patient groups.