Time needed: 1 hour and 10 minutes.

1. Risk of Medication Use for Pain Tx in Elderly
   • Decrease in muscle mass
   • Increased fat mass
   • Decreased renal clearance
   • Reduction of hepatic phase I reactions
   (oxidation, hydrolysis, reduction)
   • Decreased serum albumin
   • Increased sensitivity to centrally acting drugs

   

2. Standard Survey Process

   Pre survey sample selection (facility quality
   indicators)
   • Survey sample phase 1 & 2
   – Comprehensive/focused resident review +
   case-mix stratified (statutorily required)
   • Resident review quality of life (5C)
   – Meals, treatments, medication, ac

3. Resident QOL assessment
   – Interviews
   – Observations of residents
   • Medication pass & Pharmacy services (5E)

4. CMS Investigative Protocol for
   Pain Management (F309)

   Who states he/she has pain
   • Who displays possible indicators of pain not
   readily attributed to another cause
   • Who has a disease or condition or receives
   treatments that cause or can cause pain
   • Whose assessment indicates that
   he/she experiences pain

5. Procedures F309

   Care plan review
   • Observations
   • Resident/representative interviews
   • Nurse aide interviews
   • Record review
   – Pain assessments
   – Pertinent nonpharmacological interventions
   Criteria for Compliance with F309 for a
   Resident with Pain or the Potential for Pain
   • The facility is in compliance with F309 Quality
   of Care as it relates to the recognition &
   management of pain, IF each resident & the
   facility has provided the necessary care &
   services to attain or maintain the highest
   practical physical, mental & psychosocial wellbeing, in accordance with the comprehensive
   assessment & plan of care
   • Review: right to refuse treatment (F155)