42 CFR 483.25 F-309

1. 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

2. 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.

3. 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.

4. 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.

5. 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.

6. 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

7. 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.

8. Deficiency Categorization • Actual Harm, not immediate jeopardy • May include expressions (verbal & non-verbal) 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.

9. 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;

10. Key to Successful Pain Management DEVELOP IMPLEMENT MONITOR or MODIFY A PAIN MANAGEMENT PLAN TO TRY TO MEET THE RESIDENT’S NEEDS.