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42 CFR 483.25 F-309

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. Interpretive Guidance. To include review of resident (s) who: Have pain symptoms; Are being treated for pain;

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42 CFR 483.25 F-309

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  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.

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