In this week’s Ftag of the Week post on the CMSCG Blog, we will continue to look at pain management. The regulation at F697 is thorough, and the associated CE Pathway provides additional insight into how surveyors will look at what a facility is doing to address a resident’s pain. Let’s look at what is expected during a pain assessment.
Pain Assessment
The Interpretive Guidance (IG) states that a pain assessment or evaluation should include gathering information regarding the following, as applicable to the resident:
- Current medical conditions
- Current medications
- History of pain
- History of treatments, including whether or not each treatment has been effective
- Characteristics of pain
- How would the resident describe the pain
- What precipitates or exacerbates the pain – care, treatments or activities
- Physical issues that may cause or exacerbate the pain – i.e., movement/ treatment of site of pain/ physical examination of site
- Psychosocial concerns that may cause or exacerbate the pain
- What factors help reduce or eliminate the pain
- Additional symptoms associated with the resident’s pain – anxiety/nausea/etc.
- Impact on quality of life – mood/ functioning/ sleep/ appetite
- Resident’s goals for pain management
- Whether the resident is satisfied with his/her current level of pain control
On Survey
Surveyors will also look to identify some of the above information during resident and staff interviews. For instance, during staff interviews, they will ask about how a resident is assessed for pain, how/when staff try to identify when pain can be anticipated and how often a resident’s pain regimen is reviewed, as well as what triggers a review. The CE Pathway also directs surveyors to review the resident’s record for whether any specific assessments regarding pain have been completed, if the facility has identified the resident’s history of pain and related interventions, and if the care plan is comprehensive and reflective of the resident’s needs and preferences. Long story short – surveyors will be looking for the information listed in the bulleted list above – what will they find when they review your residents?
Citation Example (S/S: J – Immediate Jeopardy): A facility was cited with an Immediate Jeopardy for failure to adequately manage the pain of a resident due to failure to assess and recognize acute pain and immediate implement interventions to manage the resident’s pain. The resident was admitted from the hospital after surgery and had multiple broken bones. The resident asked multiple staff members for pain medication, but it was not available. Record review showed that licensed nursing staff did not assess the resident for signs of pain every shift for the first 48 hours after admission, and a pain care plan was not implemented until more than a week later. The resident complained of a pain level of 10/10 throughout the day, but most of the nurses on duty did not have access to the emergency med supply, so the resident was not provided with medication that could relieve her pain.
There is obviously a significant concern related to the failure of the facility to develop and implement an effective pain management plan for a resident who required pain management. What should also be explored in a situation such as this is the communication between nurses on a shift-to-shift basis, communication between the licensed nurses and the medical practitioner as well as how and to whom responsibility is assigned for completing a timely review of a new admission’s medical orders and plan of care to ensure that all needs are met.
