F-Tag 309:. Are You Ready?. Joan Williams, MS, CRNP Director of Clinical Services. QUALITY OF CARE. 42 CFR 483.25 (F309) Effective Date: 3/31/09. 483.25 Quality of Care.
Are You Ready?
Director of Clinical Services
42 CFR 483.25 (F309)
Effective Date: 3/31/09
covers care of residents where a
more specific regulation or
protocol does not apply
covers all aspects of pain
ESRD services (formerly in
Appendix P; moved, not changed).
GENERAL of Care
(actual and potential)
(restarts the assessment circle)
there is a plan, intervention, and evaluation.
Pain of Care
“an unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage”
International Association for the Study of Pain (IASP)
Acute-initially present due to the onset of
symptoms or treatment of a disease
Chronic-persistent beyond the usual of
expected course of a disease or
after a reasonable time for an
injury to heal
known to be present in approximately 80% of institutionalized elderly clients.
2008 American Conference on Pain
Often chronic in the elderly; in point of fact the elderly are believed to have twice the prevalence of chronic pain as the general population.
Most importantly– approximately 45-80% of LTC residents are estimated to have
substantial pain that is undertreated.
American Geriatrics Society
Pain is a major factor in
QUALITY OF LIFE
each of our clients.
In order to effectively manage pain, we must believe that it is possible to control and manage this symptom on an ongoing basis with positive outcomes for our residents.
….regularly…..according to your policy and procedure. This may be daily, every shift, every x-number of hours, or however frequently your policy states.
….regularly is not once a month (MDS).
Methodically (with a method)…
Analyze in order to communicate with
the provider to get effective
Symptom analysis is the simplest way.
what does this keep you from
what level of pain is tolerable?
With consistency or uniformity….
By using a format or scale which can be
validly and reliably used by your
Do what works in your facility.
Do it regularly, consistently, and methodically.
then the care plan must address it.
The RAP does not have a specific place labeled ‘pain’ right now. However pain may come out in a number of areas. If you have a number of these noted, look for pain.
Should address physical, emotional,
social, and spiritual aspects of pain.
Restarts the circle of pain control.
We really keep assessing/working and reworking the plan/evaluating its effectiveness and re-assessing the client’s needs.
Analysis of Pain Control may use different types of documentation, but the net goal is to try to see what works, how long it worked, what factors affected it working, and what the client thought of the pain relief.
The reference sections included in the CMS 1/23/09 guidance section related to the pain management protocol are excellent and provide many varied approaches to supplement your personal and staff education.
If the problem occurs, you assess and care plan a strategy according to your policy and procedure. Make sure you communicate the plan as well.
facility allowed, caused, or situation resulted in serious injury, harm, impairment, or death to a resident and requires immediate correction. ‘severe, unrelenting, excruciating, and unrelieved pain’
indicated non-compliance resulting in actual harm related to clinical compromise, decline, or inability to maintain and/or reach his/her highest practicable well-being ‘compromise of function with subsequent additional symptoms, or episodic pain related to treatments or interventions’
Noncompliance resulting in resident outcomes of minimal discomfort, potential inability to reach/maintain highest level of well-being, or complaints of moderate discomfort/ pain. Potential for greater discomfort.
Questions? it is possible to control and manage this symptom on an ongoing basis with positive outcomes for our residents.