Pain: Facility Assessment Checklists


This is a series of self-assessment checklists for nursing home staff to use to assess processes related to pain management in the facility and to identify areas that need improvement.

These checklists are meant to help start a Quality Improvement project and focus on patient assessment and treatment so that they can be used in conjunction with the Pain Audit Checklists and Pain Data Tracking Tool in the QI section of the GeriatricPain website. There are three separate Checklists that can be completed. While the Checklists themselves can be done at the same time, not all of these processes should be started as a QI project at the same time. It is best to review the Checklists and establish priorities for your facility. This might be done by conducting a brain-storming session to identify the most prevalent problems with pain management in your facility.


  • The Checklists are designed for completion by a director of nursing (DON), DON designee, or other team leader who knows the facility.
  • The person completing the Checklist should consult with appropriate staff and older adult’s medical records to ensure the most accurate information.

Use these Checklists as the starting point for a quality/performance improvement project. They can be used along with the Recommended Pain QI Questions, the Pain Audit Checklists, the Random Sampling Strategy, the Pain Data Tracking Tool, the Steps to QI Worksheets and the Advancing Excellence: Improving Pain Management Implementation Guide


Checklists on the following pain-related topics are included:

  • Assessment upon Admission/Readmission/Change of Condition
  • Care Plan that includes Older adult/Family Goals for Pain
  • Pain Treatment and Monitoring
  • Pain Reassessment
  • Pain management

Pain: Facility Assessment Checklists - see more detail in PDF Version