No More Silent Suffering: Achieving 100% Pain Assessment Compliance for People living with Advanced Dementia on Geriatric Medicine Wards

Introduction

Over 850000 people in the UK live with dementia. For those with advanced disease, pain cannot be reliably self-reported and requires structured assessment to be identified. Despite NICE guideline NG 97 and MFT Trust guidance, pain assessment on our geriatric wards was inconsistent, leaving the most vulnerable patients at risk of silent or unrecognized suffering.

Method

A baseline retrospective audit of EPIC (HIVE) electronic records reviewed all eligible admissions to geriatric wards between June and August 2025. Inclusion criteria were patients aged more than 65 years with moderate to severe dementia unable to verbally self-report pain. Gaps were identified and three targeted interventions were initiated. Through ward-based PAINAD assessment education huddles, formal teaching sessions for medical and nursing staff and eye catching PAINAD information posters across clinical areas we drove the change. A re-audit using identical methodology was conducted after 3 months.

Results

Baseline compliance stood at only 70%, which meant that 3 in 10 of our most vulnerable patients were not being systematically assessed for pain. Following intervention, reaudit demonstrated 100% compliance.

Conclusion

This QIP with low-cost interventions delivered rapid and complete transformation in pain assessment practice. We were able to ensure that all eligible patients were able to receive pain assessment irrespective of their ability to communicate, thus improving patient safety and experience. This project demonstrates that with targeted education and environmental prompts meaningful patient safety improvement is achievable quickly and sustainably. Continued audit cycles are scheduled to ensure sustained compliance.