• Salla Grommi, Ari Voutilainen, Anne Vaajoki, and Päivi Kankkunen.
• Department of Nursing Science, University of Eastern Finland, Kuopio, Finland. Electronic address: sallagro@student.uef.fi.
• Pain Manag Nurs. 2025 Jan 30.

PurposeThe study aimed to determine how pain documentation audits and repeated feedback (REFPAD intervention) affect registered nurses' pain documentation and knowledge, and to discover how background variables relate to such documentation and knowledge.DesignA cluster randomized trial.MethodsThirty work units in a university hospital were randomized into intervention (n = 15) and control (n = 15) groups. The intervention group received monthly pain documentation audits and feedback, while the control group received no feedback. A pain knowledge test was conducted in three phases. Data were collected from February to November 2022. A linear mixed model was used to detect the effects of the REFPAD intervention.ResultsThe REFPAD intervention positively affected pain documentation quality, but its statistical significance was lost because of substantial within-unit variation. At baseline, pain documentation quality scores were in intervention 35% and control 38%. After 8 months of feedback, the quality scores were 44% and 43%. The number of pain assessments per patient per day was the only factor that affected pain documentation quality. The REFPAD intervention had no effect on pain knowledge.ConclusionsThe REFPAD intervention may improve pain documentation quality. A more comprehensive analysis of implementation barriers and facilitators is needed to reduce variations between and within work units.Clinical ImplicationsMore focus should be paid to feedback implementation and continuous monitoring of the quality of pain care is recommended.Trial RegistrationClinicalTrials.gov Identifier: NCT05373641. Registration date: February 22, 2022.Copyright © 2025. Published by Elsevier Inc.

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