Transcript 42 CFR 483.25 F-309 - Empire Quality Partnership

42 CFR 483.25
F-309
Quality of Care
Pain Management
Changes to Interpretive Guidance
NYS Department of Health
Office of Long Term Care
Division of Residential Services
Interpretive Guidance
To include review of resident (s) who:
Have pain symptoms;
Are being treated for pain;
Have the potential for pain symptoms
related to conditions or treatments
PAIN: An unpleasant sensory and
emotional experience that can be acute,
recurrent or persistent.
Provider Expectations
Identify when pain is present or can be
expected;
Pain evaluation and, to the extent possible,
identification and treatment of the cause(s)
of pain;
Identification of resident goals for
management of pain;
Implementation of interventions to prevent or
manage pain in accordance with the
comprehensive care plan and current
standards of practice.
Recognize Common
Misconceptions
A normal part of aging;
Sign of weakness;
An attention seeking mechanism; or that
Elderly and cognitively impaired residents
have a higher tolerance.
Failure to report pain must not be interpreted
as absence of pain in elderly or cognitively
impaired residents.
Barriers to Pain Recognition
Language and/or cultural barriers;
Non-specific, vague symptoms; Non-verbal
behaviors;
Co-morbidities;
Staff turnover, workload;
Lack of education about pain symptoms;
Lack of familiarity with the usual/customary
behaviors and routines of nursing home
residents.
Undetected/Untreated Pain
May lead to
Anorexia;
Gait disturbance;
Generalized de-conditioning and falls;
Anxiety;
Depression;
Decreased participation in usual activities;
Inability to fall asleep;
Diminished quality of life
Determination of Non-Compliance
May include the Provider’s failure to
Recognize and evaluate the resident experiencing
pain to allow for individualized pain management;
Develop interventions for residents experiencing
pain;
Provide pain management interventions in
situations where pain can be anticipated (ie dental
extractions, surgery);
Implement interventions to address pain that is
consistent with resident goals and current
standards of practice;
Monitor the effectiveness of intervention(s) to
manage pain;
Coordinate pain management with all IDT
members.
Deficiency Categorization
Actual Harm, not immediate
jeopardy
May include expressions (verbal & nonverbal) of persistent pain that has
compromised the resident’s functioning
Decreased participation in social
interactions, and/or intermittent
crying/moaning, weight loss, and/or
diminished appetite.
Deficiency Categorization (cont.)
No Actual Harm with the potential for
more than minimal harm
Minimal discomfort;
No compromise in physical or
psychosocial functioning;
Minimal or episodic pain or discomfort
related to care/treatment;
Key to Successful Pain
Management
DEVELOP
IMPLEMENT
MONITOR or MODIFY A PAIN
MANAGEMENT PLAN TO TRY TO
MEET THE RESIDENT’S NEEDS.