As MDS Coordinator and Director of Rehab at Park View Post Acute, Claudia and Jennifer observed that there was ongoing discrepancy between pain levels reported by OT/PT/ST and Nursing for the same patients. In addition, many patients were continually stating that they had 10/10 pain and that was being documented in the medical record, but they were not demonstrating behaviors consistent with that high pain level.

Requirements
From RAI Manual: Facility policy should provide standardized tools to use throughout the facility in assessing pain to ensure consistency in interpretation and documentation of the resident’s pain.

Surveyors interview question: Is there a tool used to assess residents with pain? Is the same tool used for everyone? How is the resident assessed for pain? How and when do staff try to identify circumstances in which pain can be anticipated?

Challenges
Nursing and Therapy were not utilizing the same pain tool, resulting in conflicting reports of pain at the Medicare Meeting, in clinical documentation and in MD reporting. Inaccurate reporting was negatively affecting optimal pain control via both pharmacological and non-pharmacological interventions. There was also patient confusion regarding their levels of pain due to lack of education on how to report it.

Solutions
To address these challenges, we researched available pain tools and chose one that had a clear interpretation of pain. We also researched the federal and state regulation requirements regarding assessment of pain to ensure that we were meeting the standards. We then shared our plan with the IDT Team and the Medical Director for buy-in.

Next, we collaborated on the development of an in-service training module for nurses and therapists that emphasized consistent training on the use of the tool with each patient. We copied and laminated the pain assessment tool for each therapist, nurse and skilled patient bed. In collaboration with the Director of Nursing, we scheduled and completed in-service group training for all nursing clinical team and therapists. We monitored implementation during Medicare meeting team reports and MDS patient interviews.

Conclusions
Our efforts resulted in a decrease in patient reports of 10/10 pain following education on the pain assessment tool. We saw greater success in conversations with patients regarding their pain levels and their response to interventions. We also saw an increased ability for the clinical team to identify actual changes in pain levels, plus increased collaboration between Nursing and Therapy regarding pain management because they are all “speaking the same language.”

Moreover, there is increased physician satisfaction due to more consistent reporting by Nursing and Therapy. Patients also have greater satisfaction due to better communication with staff and involvement in their own pain control.

View poster: Committing to Consistency in Pain Management (PDF format)
 

Claudia Alexander, RN MDS Resource and Jennifer Raymond, MS SLP Therapy Resource