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
    • 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)

Non Pharmacological Treatment

Options for those who want an alternative to prescription drugs or are addicted and want to refrain from pharmacological options.


Nursing intervention for pain tool checklist




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