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.
Each facility should have a system to assess and measure pain before and after administering PRN pain medication. Harmony recommends utilizing this data to develop a patient specific plan of care. Effective pain recognition and management requires an ongoing facility-wide commitment to patient comfort. The facility goal should be "to help a patient attain or maintain his or her highest practicable level of well-being and to prevent or manage pain, to the extent possible". The interdisciplinary team (nurses, practitioner, pharmacists, etc.) is responsible for developing a pain management regimen that is specific to each patient who has pain or who has the potential for pain (such as during a treatment).
Recognize when the patient is experiencing pain and identify circumstances when pain can be anticipated. Patterning PRN utilization of pain medication may assist the facility in anticipating pain.
Evaluate the existing pain and the causes. Consider a detailed pain assessment that identifies causes, pattern and sets goals. Given the acute nature of the patient population, this may need to be repeated throughout the patients stay.
Manage or prevent pain, consistent with the comprehensive assessment and plan of care, current clinical standards of practice, and the patient's goals and preferences." Consider non-pharmacologic interventions.
Re-assess pain and adjust the plan of care. The patient may be experiencing acute pain on admission due to an acute episode (fracture, surgery). As the patient's condition improves, there may be less reliance on pharmacologic interventions and the potential to reduce or eliminate the need for pharmacologic interventions. Consider moderate pain as a trigger for re-assessment.
Next week Harmony will discuss Non-pharmacologic and pharmacologial approaches for pain management in the SNF setting. Harmony Healthcare has additional information on this topic and can assist faciliites through this process. Please contact us for more information.