The power of AI that is giving care home residents a voice

A state-of-the-art medical device with unique innovative pain assessment technology is helping staff at Orchard Care Homes identify if residents living with dementia are in pain.

The population of people living with dementia is set to triple by 2050, according to recent data published by Alzheimer’s Society. Currently, around 70% of people living in care homes have a form of cognitive impairment which sometimes leaves them unable to reliably communicate their pain, which in turn goes unrecognised and therefore untreated.

Orchard Care Homes has been running care homes across the UK for over a decade and has established a strong reputation in the care industry for providing quality care for the elderly.

With 23 care homes in the North West, North East, Yorkshire and the Midlands, Orchard is the largest care provider in the UK to use the world’s first AI-powered pain assessment tool PainChek®, to identify pain in its residents living with dementia. 

PainChek® is a secure medical device for use on mobile care devices and tablets and uses artificial intelligence (AI) (facial detection and analysis technology) and smart automation to detect and score pain in real time. 

Since Orchard integrated PainChek® into its comprehensive dementia strategy, it has seen many positive outcomes for its residents, including a 100% increase in pain assessments for those unable to verbalise pain, a reduction in distress response behaviours, and a reduction in the use of benzodiazepines and antipsychotics. 

Hannah Miller, Dementia Lead at Orchard, explains: “Integration of PainChek® in Orchard Care Homes’ electronic care plan system (PCS) has enabled our nursing teams to closely monitor and assess the pain experience of individuals in their care using a mobile care device, providing staff with a long-term view of when a resident is likely to experience pain. 

“Orchard strives to incorporate technological advances and put them into practice to ensure we are enabling all our residents to achieve good outcomes and be afforded equitable care regardless of their cognitive ability or ability to self-report health concerns such as pain. Residents who are not able to effectively verbally communicate pain that were previously disadvantaged are now on an equal footing with those that can communicate effectively. 

“As a supporter and advocate of digital technology, Orchard has also introduced a mobile care monitoring system and an electronic medication management system and has developed an in-house governance digital dashboard. Alongside PainChek®, these systems support staff to focus their time and skills on where they are most needed and improve work efficiency.  

“PainChek® empowers our workforce to conduct effective pain assessments in people that cannot reliably verbalise their pain,” she adds. “The app is easy to use, and staff feel motivated when they see the positive impact they can make in minutes. 

“Orchard is sharing the data with clinicians to effect change: paramedics can see pain levels, and families feel reassured that we have the latest technology to help those living with dementia.” 

Innovative approach

Prior to the introduction of PainChek®, pain assessment was not approached with consistency. PainChek® was introduced at some of Orchard’s homes in January 2021, and pain assessments increased significantly from a baseline of infrequent assessments that were completed subjectively and often went unrecorded.  

Orchard’s innovative approach supports the team in meeting the NICE guidance NG97: management of non-cognitive symptoms of dementia, and includes:

• Teams prompted to assess the individual for pain as a primary evaluation of the potential cause of the distress. 
• If pain is identified, treatment is provided, and the efficacy monitored (follow-ups). 
• If pain is not identified, then this can be ruled out and further causes of the person’s distress can then be explored.

Reviews and assessments 

External health professionals now request residents’ pain charts and reports from Orchard, available from the PainChek® data portal. 

“Orchard is proactively reviewing intervention and data outcomes to improve quality of life,” explains Hannah. “At the micro level, clinicians can effect positive change for a resident. At the macro level, we can see the ‘pain burden’ across the estate.

“When a resident is experiencing distress – communicated through behaviour that may have previously been viewed solely through the lens of dementia – PainChek® assessments are added to the care monitoring system.

“The app is unique in the way in which it has been developed within social care, for social care, and Orchard is proud to have rolled out the innovative technology to the Orchard estate with conviction.”

Real world delivery

Orchard achieved effective pain management for a resident, enabling a trial stop of the anti-psychotic medication they were taking. 

• The resident had frequently administered PRN pain relief. PainChek® assessments of the resident identified pain following administration of pain relief, which prompted a change in medication and the frequency of administration. 
• The resident’s average pain score decreased considerably, and their emotional support records show a 50% reduction in distressed behaviours thought to be caused by pain. 
• Through this innovative delivery of care, the resident’s pain is under control, and they are showing increased engagement and socialisation.  

As regular pain relief has increased, there has been a drop in the use of PRN pain relief, and so Orchard residents’ pain is better managed. This has also contributed to a decrease in use as well as in dosage of psychotropic medication administered to residents. 

As a direct result, since January 2021, the number of residents with regular pain relief available has increased from 25% to around 75%, as pain is now being identified and treated effectively. 

PainChek®’s ‘follow up’ report shows how quickly a pain assessment was followed up – this level of information has never been seen in the UK before. In June, 83% of severe pain assessments were followed up and 100% of these resulted in a lower pain severity being recorded. 

Orchard Care Homes enhances dementia strategy with PainChek®

Daily challenge 

PainChek® Senior Business Development Manager Tandeep Gill, comments: “It is a daily challenge for carers and healthcare professionals to assess pain in people living with dementia or other cognitive impairments. Often pain goes undetected or untreated, which can lead to unnecessary prescribing of medication such as antipsychotics, behavioural and psychological issues, and decreased quality of life for residents.  

“PainChek® was developed as an effective solution to this problem, by utilising AI to address a core issue with pain assessment. It is a secure medical device for use on mobile phones and tablets, and uses AI, facial analysis technology, and smart automation, to detect and score pain in real time.  

“AI remains the foundation of the technology today. Its Pain Assessment System has an open API, facilitating the integration of PainChek® with care management systems, which allows real-time recording of pain assessments into residents’ medical records, and sharing of those results with other healthcare practitioners.”

PainChek® Marketing Officer Drew Hunt adds: “The PainChek® team is united by its goal to provide a voice to those who cannot verbalise their pain. PainChek continues to research and review the link between pain and dementia, and provide free, accessible resources and information such as whitepapers and reports to care providers across the globe to support better pain assessment and management and an enhanced level of care. A recent UK study has been published demonstrating PainChek® is a valid and reliable instrument to assess the presence and severity of pain in people with moderate-to-severe dementia living in aged care.”

PainChek is currently used in over 1,600 aged care facilities globally, with over 3000 UK care home residents benefitting from PainChek®, and more than 500,000 assessments completed using it to date. 

For further information: https://painchek.com/uk