Long Term Care Training: Ensure an Effective Pain Management Program

Pain is closely linked to depression, erodes self-confidence, and can lead to behavioural problems, particularly in nursing home residents with cognitive impairment. With a revised F309 tag specially addressing pain on its way, the stakes have never been higher for getting on top of this all too common clinical problem.  Let our expert lead you through the clinical and regulatory path to better resident comfort and a pain-free survey with this long term care training article.

What are the criteria for compliance that surveyors are going to focus on? Well, first of all, they will be looking to see that the facility recognized and evaluated the resident who experience pain to determine the causes of the pain and the guidance to surveyor’s emphases underlying causes being critical to identify as a part of this process. And also of course contributing and/or exacerbating factors as well as the characteristics of the pain and any factors that influence the pain.

The next step, as recommended by our long term care training expert, is to develop and implement interventions for pain management consistent with assessment findings and the resident’s goals. And remember the goals must be realistic and measurable. And also the care plan must address risk factors specific to this resident based on the risk assessment that you've done.

And if these requirements are not met, the guidance to surveyors actually says there must be documentation of a clinically pertinent rationale why this wasn’t done.

It is critical for compliance recognize and provide measures to minimize or prevent pain for situations where pain could be anticipated. And the next criterion for compliance monitor is monitoring the effects of interventions and modifying approaches as indicated. So they're going to be looking for this. This includes monitoring the status of the underlying causes.

The response to interventions “Are they working? Are the goals being met?” And also monitoring for the presence of adverse consequences of treatment.

There's that disconnect between actually recognizing what the side effects are connecting them with the cause and then doing something about that. So the surveyors are going to be obviously looking for that too.

Another criterion is communication with the health care practitioner. That means with the physician or the nurse practitioner, physician assistant, clinical nurse specialist depending on their scope of practice in your state. But communicating with the health care practitioner where the resident has pain that is not adequately managed or has a suspected or confirmed adverse consequence related to the treatment.

The next criterion for compliance is coordinate pain management as needed with an involved hospice of course to meet the resident’s need. And there are also kinds of regulations or long term care guidelines that talk about or hospice as well as nursing homes about the coordination of the care plans between the hospice and the nursing home so that there is one comprehensive care plan for management of pain. Everybody’s on the same page. Everybody’s on the same page. Everybody knows what needs to be done. The right hand knows what the left hand is doing.

Put together an effective pain management program

Pulling together a systematic, effective pain management program is a major effort in any facility. And it just cannot be accomplished without a firm commitment to pain management from the very top of the organization and extending throughout the facility. Everybody in the facility have to know that this is a priority.

The best approach is to develop an interdisciplinary work group made up of key staff members who can make this happen. It should include representatives from all disciplines who are involved in resident care. So this would include the DON and nurses and therapists and recreation and nutritional staff, social worker, education coordinator, medical director, everybody.

Then come the administrator and the consultant pharmacists. But if they can't be the members of the committee, they certainly should at least be ad hoc members because their input is just critical.

This work group should be appointed be the administrator and backed by the full authority and scrutiny of the administrator’s position.

And the other thing is that there are people in the facility. It could be activity aids. Its dietary aids, housekeepers, maintenance workers. Just imagine the maintenance worker or the housekeeper is in the room doing his or her job and chatting with the resident. And they become friends. You know, they develop a relationship.

And so those facility’s staff members could actually be collecting critical information or observing critical responses from the individual that tells a lot about their pain but they don’t know to share that information. So that's why this needs to be an interdisciplinary work group involving all these different disciplines and all these different folks. And then the long term care training in the facility would then include training for those folks to be able to know what to report and who to report it too.

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