Evaluation of a Pilot Project for Implementation of REPOS in Daily Practice
2009
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.
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