 QOC related to recognition & management of pain  Determine whether facility has provided & resident has received care & services to address & manage pain  Applies to residents who state they have pain, who display indicators of pain, are assessed with pain, receives pain treatment, has elected hospice benefit for pain management

 Observe residents  Interview residents or family  Interview nurse aides  Review records  Assessment  Care plan, including revisions  Interview health care practitioners & other health professionals

 Facility is in compliance if EACH resident has their pain managed in alignment with their goals to attain the highest practicable physical, mental, & psychosocial well-being  Recognized & evaluated pain to determine cause  Developed & implemented comprehensive care plan  Provided measures to minimize, prevent, or treat pain  Monitored effects of interventions  Communicated with health care practitioner when appropriate to obtain new orders or revise current orders

 Failure to show adequate proof that ALL of the previous steps are followed is non-compliance  Non-compliance can be at any step along the way  Recognize & evaluate  Intervene & treat  Prevent or minimize  Monitor  Communicate & coordinate

 F155 – Right to refuse treatment  Facility must assess reason, clarify & educate resident of consequences, offered alternatives & documented these steps  F157 – Notification of changes  Health care practitioner notified if pain persisted or there were adverse consequences  Notified responsible party of changes  F242 – Self-determination & participation  Facility provided resident with relevant options to manage pain

 F246 – Accommodation of needs  Adopted resident’s physical environment to reasonably accommodate resident’s pain  F272 – Comprehensive assessments  Was a comprehensive assessment done  F278 – Accuracy of assessments  Does the assessment reflect the resident’s condition

 F279 – Comprehensive care plan  Did care plan include measureable objectives, time frames, & specific interventions/services  Was it consistent with resident’s risks, needs, goals, preferences, & current standards of practice  F280 – Comprehensive care plan revision  Ensure periodic review of plan & revision as needed by qualified TEAM with input from resident or responsible party

 F281 – Services meet professional standards of quality  F282 – Care provided by qualified person in accordance with plan of care  F329 – Unnecessary drugs  Are medications monitored for effectiveness & adverse consequences  Are symptoms resident has related to meds

 F385 – Physician supervision  Is pain management supervised by physician, including participation in comprehensive assessment process, development of treatment regimen, monitoring & response to notification of changes in resident status  F425 – Pharmacy services  Were medications available & administered as indicated, ordered at admission & throughout stay

 F501 – Medical Director  Did Medical Director help develop & implement appropriate policies consistent with standards of practice  Did Medical Director interact with resident’s physician supervising the care if requested by facility  F514 – Clinical records  Did clinical records accurately & completely document resident status, care/services provided, in accordance with standards & resident goals  Did records provide a basis for determining & managing resident progress & responses to care

Adapted and used with permission of D. Bakerjian, PhD, MSN, APRN, University of CA, San Francisco, 2009.