She was labeled agitated. Nobody had asked about her back.

She was labeled agitated. Sundowning, the note said. Started on a low-dose antipsychotic three days in.

Nobody had asked about her back.

She had advanced dementia and a compression fracture from the fall that sent her to us. She couldn't tell anyone it hurt. So it came out as hitting during transfers and pulling away from the therapist.

Here's the part I'd push back on. We call that a behavior. In someone who can't report pain, agitation during movement is a pain assessment. It's just one nobody charted as such.

She went to a scheduled regimen instead of PRN. The hitting stopped in about four days. The antipsychotic came off.

I'm not telling this to say somebody made a bad call. The nurses flagged the behavior correctly and fast. The gap is the tool. We ask a resident to rate pain zero to ten, and the residents who most need that assessment are the ones who can't complete it.

If your pain assessment depends on a resident answering a question, you're missing every resident who can't answer it.

How are your teams documenting pain in someone who can't report it?