Harmony Healthcare Blog

Five Strategies for Pain Management

Posted by Pam Duchene on Thu, Oct 04, 2018


Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

A key area of concern within the IMPACT (Improving Medicare Post-Acute Transformation) act is that of preventing pain and alleviating suffering occurring in older adults in skilled nursing facilities.  The Nursing Home Quality Improvement Campaign provides ongoing reporting on state and national rates of Quality Measures, including the rate for residents self-reporting moderate to severe pain. 

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Topics: Pain Management

Exploring Pain Management Goals in the SNF with Advancing Excellence

Posted by Kris Mastrangelo on Fri, Sep 25, 2015

Many Skilled Nursing Facilities become concerned when they note that their long and short stay Quality Measures for patients who self-report Moderate to Severe Pain is elevated above facility benchmarks or national averages.  This concern is justified and opens an excellent opportunity to investigate current facility practices for pain control.  In order to improve the quality of care and quality of life of residents, it is important that SNFs establish and promote Pain Management Goals within their facility.

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Topics: Pain Management, advancing excellence

Pain Management Intervention

Posted by Peter Mastrangelo on Wed, Oct 17, 2012

Pain management should be an interdisciplinary approach.  For example, nursing can look at PRN versus scheduled medications and what time those medications are administered.  Both therapy and nursing can look at the provision of hot packs, ice packs, therapeutic exercise, range of motion, and positioning techniques.  Your activities department is a hidden resource.  They can help the patient with visualization, relaxation techniques and provide the patient with activities to help distract them from their pain.  Whatever intervention you put in place, you want to make sure it is care planned appropriately and reviewed regularly.  That way you know you have the best intervention in place to help manage your patient’s pain.

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Topics: Pain Management, Therapy, Medicare Minute

Assessing Pain in the SNF

Posted by Peter Mastrangelo on Wed, Sep 26, 2012

Many times as consultants when we go into buildings the staff expresses to us that they are having difficulty treating the patients.  Reason being the patient is typically in too much pain.  First on the agenda should be to find records and  look at the documentation for that pain.  Therapy and Nursing can be documenting the type of pain, the location of pain, and the intensity of the pain.  A facility should glance at how they are documenting intensity of pain as there are a number of different scales.  You can use a numeric scale, verbal scale, or a pictorial scale depending on your population.  Once you have got the pain management documented, then you can start looking at the interventions you want to put in place.  Tracking that documentation is going to help you determine those interventions.

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Topics: Pain Management, Pain Assessment, Pain Documentation, Modalities

Pain Management Intervention - Medicare Minute

Posted by Peter Mastrangelo on Wed, Mar 14, 2012

Pain Management Intervention - Medicare Minute

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Topics: Pain Management, Medicare Minute

Pain Management & Documentation - Medicare Minute

Posted by Peter Mastrangelo on Wed, Feb 15, 2012

Pain Management & Documentation- Medicare Minute

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Topics: Pain Management, Pain Documentation

Pain Management Tips and Strategies in a SNF

Posted by Kris Mastrangelo on Wed, Jun 02, 2010

Pain Management Tips and Strategies in a SNF
Harmony has been educating SNF facilities in the new guidance under F309 issued April 2009 that states that nursing facilities must assess and address pain in all patients, including the cognitively impaired.

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Topics: Pain Management

Pain Management Strategies in a SNF; Part II

Posted by The Harmony Team on Wed, Jun 02, 2010

Pain Management Strategies in a SNF: Part II
Non-pharmacologic interventions may help manage pain effectively when used either independently or in conjunction with pharmacologic agents. Examples of non-pharmacologic approaches may include, but are not limited to:
Altering the environment for comfort (such as adjusting room temperature, tightening and smoothing linens, using pressure redistributing mattress and positioning, comfortable seating, and assistive devices).
Physical modalities, such as ice packs or cold compresses (to reduce swelling and lessen sensation), mild heat (to decrease joint stiffness and increase blood flow to an area), neutral body alignment and repositioning, baths, transcutaneous electrical nerve stimulation (TENS), massage, acupuncture/acupressure, chiropractic, or rehabilitation therapy.
Exercises to address stiffness and prevent contractures.
Cognitive/Behavioral interventions (e.g., relaxation techniques, reminiscing, diversions, activities, music therapy, coping techniques and education about pain).
Pharmacological interventions considerations:
The regimen considers factors such as the causes, location, and severity of the pain, the potential benefits, risks and adverse consequences of medications; and the patient's desired level of relief and tolerance for adverse consequences. The patient may accept partial pain relief in order to experience fewer significant adverse consequences (e.g., desire to stay alert instead of experiencing drowsiness/confusion). The interdisciplinary team works with the patient to identify the most effective and acceptable route for the administration of analgesics, such as orally, topically, by injection, by infusion pump, and/or transdermally.
It is important to follow a systematic approach for selecting medications and doses to treat pain. Developing an effective pain management regimen may require repeated attempts to identify the right interventions. General guidelines for choosing appropriate categories of medications in various situations are widely available.
Factors influencing the selection and doses of medications include the patient's medical condition, current medication regimen, nature, severity, and cause of the pain and the course of the illness. Analgesics may help manage pain; however, they often do not address the underlying cause of pain. Examples of different approaches may include, but are not limited to: administering lower doses of medication initially and titrating the dose slowly upward, administering medications "around the clock" rather than "on demand" (PRN); or combining longer acting medications with PRN medications for breakthrough pain. Recurrent use of or repeated requests for PRN medications may indicate the need to reevaluate the situation, including the current medication regimen. Some clinical conditions or situations may require using several analgesics and/or adjuvant medications (e.g., antidepressants or anticonvulsants) together. Documentation helps to clarify the rationale for a treatment regimen and to acknowledge associated risks.
As the patient ages, we are faced with a higher potential for multiple drug-drug and drug-disease interactions. When treating pain in this population, the benefits and risks of rational polypharmacy may be more complex compared to the population at large. The most common reason for constipation due to medications is pain medications.

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Topics: Pain Management

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