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Background  Pain is often underassessed and undertreated among long-term care (LTC) residents living with dementia. When used regularly, the Pain Assessment Checklist for Seniors With Limited Ability to Communicate (PACSLAC) scales have been shown to have beneficial effects on pain assessment and management practices and stress and burnout levels in frontline staff in LTC facilities. Such scales, however, are not utilized as often as recommended, which is likely to be related to additional record-keeping and tracking over time involved with their paper-and-pencil administration.    Objective  Using implementation science principles, we assessed the introduction of the PACSLAC-II scale by comparing two methods of administration—a newly developed tablet app version and the original paper-and-pencil version—with respect to the frequency of pain assessment and facility staff feedback.    Methods  Using a case series approach, we tracked pain-related quality indicators at baseline, implementation, and follow-up periods. A quasi-experimental design was used to evaluate the effect of the method of administration (ie,  paper-and-pencil only  [n=18],  tablet only  [n=12],  paper-and-pencil followed by tablet app  [n=31], and  tablet app followed by paper-and-pencil  [n=31]) on pain assessment frequency and frontline staff stress and burnout levels. Finally, semistructured interviews were conducted with frontline staff to obtain perspectives on each method of administration.    Results  The implementation effort resulted in a great increase in pain assessment frequency across 7 independent LTC units, although these increases were not maintained during the follow-up period. Frontline staff reported lower levels of workload in the  paper-and-pencil followed by tablet app condition  than those in the  paper-and-pencil only  ( P <.001) and  tablet app followed by paper-and-pencil  ( P <.001) conditions. Frontline staff also reported lower levels of workload in the  tablet-only  condition than those in the  paper-and-pencil only  condition ( P =.05). Similarly, lower levels of emotional exhaustion were reported by frontline staff in the  paper-and-pencil followed by tablet app  condition than those in the  paper-and-pencil only  ( P =.002) and  tablet app followed by paper-and-pencil  ( P =.002) conditions. Finally, frontline staff reported higher levels of depersonalization in the  paper-and-pencil only  condition than those in the  tablet app only  ( P =.008),  paper-and-pencil followed by tablet app  ( P <.001), and  tablet app followed by paper-and-pencil  ( P <.001) conditions. Furthermore, narrative data from individual interviews with frontline staff revealed a preference for the tablet app over the paper-and-pencil method of administration.    Conclusions  This study provides support for the use of either the tablet app or the paper-and-pencil version of the PACSLAC-II to improve pain-related quality indicators, but a reported preference for and lower levels of stress and burnout with the use of the tablet app method of administration suggests that the use of the tablet app may have more advantages compared with the paper-and-pencil method of administration.

Behavioral Pain Assessment Implementation in Long-Term Care Using a Tablet App: Case Series and Quasi-Experimental Design