Evaluation of a Pilot Project for Implementation of REPOS in Daily Practice
Abstract: Pain assessment in elderly people with a communication disability is a well-known problem. Objective: To explore the feasibility of a new pain observation scale. Study group: Fifteen nurses employed at eight wards in one nursing home. Methods: We developed the Rotterdam Elderly Pain Observation Scale (REPOS), which includes 10 behavioral items scored as present (1) or absent (0) after a 2-minutes observation. In addition, pain level is rated on the Numeric Rating Scale (NRS). A REPOS score of ≥3 in combination with a NRS of ≥4 indicates pain. Fifteen nurses received a 2-hours theoretical training, and performed paired bedside observations with the trainer. After obtaining a sufficient interrater agreement, nurses were asked to continue REPOS observations. These data were examined after six months. Results: All nurses reached sufficient interrater agreement (kappa ≥ 0.61) within a median of 8 weeks (range 4 to 10), after a median of 12 observations. The next 6 months, in total 52 observations were completed by seven nurses at five different wards. Combined REPOS and NRS scores indicated pain in 22 (42%) of 52 observations. In most of these cases (77%) nurses took action as indicated in the decision tree that comes with the REPOS. Conclusions: The REPOS is feasible in daily nursing practice provided training is given. The decision tree was a useful guide for nurses to reflect on residents’ pain and take appropriate action.