MDS Corner with Judy, RN

Judy Bagby, RN, is back for MDS Corner.  In this week's installment: Pain

 

 

MDS Corner:  Pain

Judith Bagby BSN, RAC-CT, C-NE, LNHA

  This week I would like to discuss Pain Management and Section J of the MDS.  The item sets in MDS 3.0 that are specific to pain coding are J0100, J0200, J0300-J0600, J0700, J0800 and J0850.  As you look at these questions it is easy to see items that should be noted not just during the week of observation but routinely.  During review of 2567s the citing for inadequate pain management processes have been noted.  The goal of this week’s tips is to assist with the reduction or elimination of this finding during the survey process.

  Management of pain is important because it impacts quality of life.  Vital signs (B/P, pulse, respiration, and temperature) establish baselines, effectiveness of treatment, and onset of infection.  Pain has been added to the vital sign activity to become known as the 5th vital sign because of its impact on one’s living.  When someone is experiencing pain there can be an adverse effect on their nutrition, sleeping, behavior, mobility, and socialization.  There can be negative outcomes that include weight loss, impaired skin/pressure ulcers, infection, decreased participation in rehab, and increased use of behavior medications.

  The RAI process includes the MDS3.0, CAA worksheets, and the Care Plan.  This process is a “living- breathing” document that requires ongoing evaluation in order that problems/concerns are identified and investigated, and approaches are implemented for the resident to have their highest level of function.  As we focus on the subject of pain it is best practice to collect information on the status through observation and interview.  This should not be limited to the MDS week of observation but should be ongoing to assist with identifying change in the resident. For best practice if pain medication is going to be administered, ( scheduled or PRN), there needs to be information in the clinical record that would reflect the pain rate, location, description (burning, knifelike, etc), and pattern of pain.  There should then be timely follow up evaluation on the success of the medication.  This evaluation process is a “root cause analysis” of resident’s pain management needs.  Question J0100 ask if there has been a review of pain management that includes non-medication interventions.

   Failing to manage resident’s pain could potentially cause early discharge from a medicare stay or a survey citation for actual harm.  Early detection of change will assist with review and adjustments to pain management needs.  It is the responsibility of all staff members to report changes that might be an early indicator of the presence of pain.  Staff taking vital signs need to remember that pain is a part of the vital sign collection.  The simple question of “are you having any pain?” can give a start to gathering information to benefit the resident.  Sometimes we forget that pain is the individual’s impression/opinion of what their pain rate is.  The staff’s communication needs to include observations of crying, groaning, facial grimacing, gait changes, pacing, refusing cares, not eating, and not sleeping as these may be related to a pain event.

  Tips:

1.     Implementation of INTERACT Stop and Watch will assist with early notification of changes and increase opportunities for intervention review and changes.

2.     Regular review of MARs to identify if there is ongoing assessment regarding pain management for the resident.

3.     Remember to try non-medication interventions before taking the medication approach.