The revised nursing home regulation F309 is due to be released this fall. Do you know what it means and how you can ensure that you care center is in compliance?
The stated intent of F309 is that the care center assists each resident with pain to maintain or achieve the highest practicable level of well-being and functioning by:
- Screening to determine if the resident has been or is experiencing pain;
- Comprehensively assessing the pain;
- Identifying circumstances when pain can be anticipated; and
- Developing and implementing a plan, using pharmacologic and/or non-pharmacologic interventions to manage the pain and/or try to prevent the pain consistent with the resident's goals.
The first step in the process is screening. It is recommended that the screening process for pain be initiated before the resident enters the doors of the care center. It is important to gather data regarding pain or discomfort from the nursing staff that are discharging the resident. In addition, speaking directly with the resident or the resident representative prior to admission will give the staff greater insight into the needs of the resident. Some questions to ask are:
- Were pain medications, heating pads, ice, and/or topical ointments used for pain or discomfort at home and how often were they used?
- Did the resident have a history of pain or discomfort?
- What were the concerns, or complaints?
- Did you observe any non-verbal signs of discomfort or distress such as grimacing, moaning, or changes in daily living skills?
- Did the resident recently have any surgeries or hospitalizations?
- Has there been any evidence or history of substance abuse?
Asking questions about the resident prior to admission is a great customer service initiative as it allows you to establish a relationship with their resident, family or representative before they enter your care center.
To comprehensively assess for pain, it must be performed over several days and several shifts. If you take a pain assessment form and go ask the resident if they are having pain upon admission, it is only a snap-shot view and does not represent a comprehensive assessment. Develop systems to gather data over several days and several shifts and utilize that data to complete the assessment. Educate and explain to the resident that pain can be more than hurting; it can be overall discomfort such as a burning, numbness, tingling, itching or other sensations which could negatively impact their daily life or rehabilitation.
Utilizing the proper assessment tools and asking the correct questions during the interviews will help the staff anticipate the resident's pain. For instance, if a resident recently had a knee replacement, it is important for the team to discuss what the resident's needs are, both before and after therapy, to maximize the individual's rehabilitation potential and to reduce their pain or discomfort level. This also involves further education for the resident regarding effective ways to communicate pain or discomfort to the nursing staff, how it can be controlled, why it is necessary to control (i.e., maximize therapy), and reassure them regarding fears of addiction.
The staff then must develop an individualized plan of care with specific goals that address pain and interventions to minimize that pain for the resident. Keep in mind that not every resident will have a pain goal of "0" and ask the resident what they feel their pain goal should be. Educate staff on pain and non-pharmacological interventions. Consider a "Pain Toolkit" to offer to your residents experiencing pain that may include soothing music, aromatherapy, a warm pack/ice pack or soothing lotion for massages.
For more information on F309 and other resources on pain management, please visit our Website at
www.pathwayhealth.com.