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Pain: a guide for facility leadership

Facility leadership Aged care staff 6 min read

By Dr Josh Hatch, FRACGP

The strengthened Quality Standards require providers to identify, monitor and manage high impact and high prevalence clinical risks, and Action 5.5.8 deals with pain 1. Its three requirements are specific enough to check.

Numbers in the text link to the 6 sources listed at the foot of this page.

What applies

  • Action 5.5.8. Processes to manage pain by assessing each person’s pain, including where they have difficulty communicating it; planning for, monitoring and responding to their need for pain relief; and ensuring pain management is available 24 hours a day 1.

  • Outcome 5.7. In palliative and end-of-life care, changes in pain and symptoms are identified and managed, with timely access to specialist equipment and medicines. In the last days, medicines for pain and symptoms, including anticipatory medicines, are prescribed, administered, reviewed and available 24 hours a day 1.

  • National guidance. The Australian Pain Society publishes Pain in Residential Aged Care Facilities: Management Strategies, in its second edition, with supporting resources that include assessment procedures for residents who can and cannot communicate and quality indicators for pain management 10.

Checking that the system works

The 24-hour requirement is a practical test. If a resident develops severe pain at 2am, can staff assess it, reach a prescriber and give an appropriate medicine within a reasonable time? The answer depends on after-hours medical access, emergency or imprest medicine supplies, and staff authorised to give them.

Records are the other test. Studies that drew on charts recorded less pain than studies that asked residents 2, so a low documented rate of pain is not, by itself, reassurance.

Questions a pain audit can answer

  • Is each resident’s pain assessed, with an observational tool where they cannot report it?

  • Is the same tool used consistently, and are scores acted on and rechecked after treatment?

  • How often are as-needed pain medicines given, and are the reasons recorded?

  • Which residents take an opioid, a gabapentinoid or both, and when were these last reviewed?

  • Are non-drug measures such as physiotherapy, positioning and activity in the care plan, and are they delivered?

  • Can pain relief be obtained at any hour, including on weekends and public holidays?

What the trials say about pain programs

Algorithm-based pain management programs in nursing homes may reduce staff-rated pain compared with usual care, but against staff education alone they made little or no difference 44. The Norwegian stepwise protocol reduced agitation as well as pain 43.

Prescribing patterns are worth watching. In South Australian nursing homes, 44% of residents prescribed any regular analgesic or related pain medicine were prescribed two or more, and 62% of those prescribed a gabapentinoid were also prescribed an opioid 5.

Working with visiting clinicians

A prescriber can respond to pain only when they hear about it. Pain scores, the use of as-needed doses and what has already been tried, passed on in a structured handover, make a review quicker and better informed.

Pharmacist medication reviews are a natural place to look at combinations of pain medicines. The medicines section describes how those reviews work.

Related pages on this site

Sources cited on this page

  1. 1 Australian Government Department of Health, Disability and Ageing. Strengthened Aged Care Quality Standards (November 2025; implemented 1 November 2025). Outcome 5.5, Action 5.5.8; Outcome 5.7, Actions 5.7.3 and 5.7.4. View source
  2. 2 Cole CS, Carpenter JS, Chen CX, et al. Prevalence and factors associated with pain in nursing home residents: a systematic review of the literature. J Am Med Dir Assoc. 2022;23(12):1916–25. (Systematic review of 26 descriptive studies, 2010–2020.) View source
  3. 5 Dowd LA, Pitkälä KH, Jadczak AD, et al. Analgesic and adjuvant co-prescribing in Australian and Finnish residential care homes. Australas J Ageing. 2025;44(3):e70062. (Cross-sectional secondary analysis.) View source
  4. 10 The Australian Pain Society. Pain in Residential Aged Care Facilities: Management Strategies, 2nd edition, and supporting resources (resource page, copyright 2019). View source
  5. 43 Husebo BS, Ballard C, Sandvik R, Nilsen OB, Aarsland D. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ. 2011;343:d4065. View source
  6. 44 Manietta C, Labonté V, Thiesemann R, et al. Algorithm-based pain management for people with dementia in nursing homes. Cochrane Database Syst Rev. 2022;4:CD013339. View source

See every source cited across the pain section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It gives no doses, and it does not recommend any procedure, clinic or practitioner. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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