Pain Management Policy

Pain Management Policy

Effective Date: [Original NPP Date]
Revised Date: [Current Date]

Policy

This facility is committed to assisting each resident to attain or maintain their highest practicable mental and psychosocial well-being by assessing pain and using interventions to prevent pain from interfering with eating, mobility, and overall quality of life. The resident's perception of pain is always considered reality, and their goals for pain management will be honored. The resident's acceptable level of pain will be determined via resident interview.

To the extent possible, the facility will:

1. Assess the potential for pain.
2. Recognize the onset or presence of pain.
3. Assess pain using a standardized pain scale of 1-10 and/or a nonverbal pain scale.
4. Address/treat the underlying causes of the pain.
5. Develop and implement interventions/approaches to pain management, both pharmacological and non-pharmacological.
6. Use pain medications judiciously to balance the resident's desired level of pain relief with the avoidance of unacceptable adverse consequences.
7. Monitor appropriately for effectiveness and/or adverse consequences.
8. Modify the approaches as necessary.

Assessment

The goal of the initial assessment of pain is to characterize the pain by location, intensity, and determine the etiology of pain, if possible. Essential to the initial assessment are:

1. History and physical examination.
2. Psychosocial assessment.
3. Diagnostic evaluation.

The resident, resident’s family, and direct care staff should be interviewed about pain using standard pain assessment questions (e.g., acceptable level, alleviating factors, etc.).

The resident is assessed for pain when the following occurs:

1. Admission and Readmission:
   • A complete physical assessment is done and documented on the Nursing Admission Form if the pain is in a specific part of the resident’s body. The admitting MD is notified, and appropriate orders for pain relief are obtained. If the resident is non-verbal or unable to express their thoughts clearly, the admitting nurse should assess and document non-verbal symptoms of pain.
2. Change in Resident Condition:
   • With a new onset of pain and/or potential for pain, including significant alterations in skin integrity.
   • When a resident reports new onset or worsening pain, a Pain Assessment is done, as well as a Physical Assessment and notification of the physician. Identifying the etiology of pain is essential to its management. In residents with dementia of any etiology, changes in behavior may indicate pain.
3. Prior to and after the administration of pharmacological or non-pharmacological interventions.
   • Pain is documented on the Medication Administration Record, Treatment Administration Record, or Nurses’ Notes.

Treatment Plan Development

The Interdisciplinary Team will review the location, type, and level of pain, the resident’s acceptable level of pain, and the resident’s pain management goals. They will develop a comprehensive plan of care that addresses the resident’s assessed needs and goals.

Monitoring for Effectiveness

The resident’s response to the pain management treatment plan will be monitored. The treatment plan will be modified as appropriate if it is ineffective in managing the resident’s pain, if there are adverse consequences, and/or if there is a change in the resident’s pain management goals. The effectiveness of the pain management treatment plan will be reviewed at Resident Care Plan meetings.

Discharge Planning

Residents, families, and/or receiving facilities should be given a written copy of the resident’s pain management treatment plan as part of discharge instructions.

References:

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM]
• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]