F-tag 309 for Pain: Survey Protocol & Related F-tags

1. F-tag 309 for Pain: Survey Protocol & Related F-tags

2. Investigative Protocol • 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

3. Survey Procedures • Observe residents • Interview residents or family • Interview nurse aides • Review records • Assessment • Care plan, including revisions • Interview health care practitioners & other health professionals

4. Determining Compliance • 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

5. Noncompliance Determination • 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

6. Relationship with other f-tags

7. Related or Associated F-tags • 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

8. Related or Associated F-tags • 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

9. Related or Associated F-tags • 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

10. Related or Associated F-tags • 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

11. Related or Associated F-tags • 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

12. Related or Associated F-tags • 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

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