TIP OF THE WEEK
Proper coding of pain: Part two
By Patsy Strouse, RAI Coordinator for Ohio
The Resident Assessment Instrument (RAI) User's Manual states that pain should be coded according to the frequency of pain and the highest level of pain that occurred during the observation period. The Minimum Data Set (MDS) captures the following levels of pain intensity: mild pain, moderate pain, or horrible or excruciating pain.
The MDS 2.0 at J2a and J2b is only capturing pain symptoms and not pain management. If you have a resident that is on pain management and receiving regular doses of pain medications, but does not complain of any pain during the observation period it would be coded a “0” (no pain). Likewise, if the resident complains of any pain, then it would be coded accordingly.
CODING FOR PAIN
Pain scales. If your facility is using a 0-5 or 0-10 point scale to assess pain, do the numbers on the pain scale match the level of pain that the resident is actually experiencing? For example, we know that on a 0-5 scale, 0= no pain, 1=mild pain, 2=mild to moderate pain, etc… If the resident reports a “2” on a 5-point scale, is the resident experiencing mild pain or moderate pain? One cannot simply assume that 2 = moderate pain. For some residents, 2 = mild pain. If a resident reports pain at a “2” or a “4” on a 5-point scale, further investigation may be required to ensure accurate coding.
Challenges sometimes arise when more than one department documents pain. For example, therapists and other staff (such as activity staff) often identify the presence of pain and document their findings. All staff members (full time and contracted employees) who document pain should use a consistent pain rating scale and should also be taught how their documentation affects MDS coding.
The most important thing is interviewing the resident and coding pain according to what the resident says or shows. When in doubt, always code for the most severe level of pain and use good clinical judgment.
RESIDENTS' PAIN GOALS
Don't forget that good nursing practice includes documenting the effectiveness of pain medications or other interventions. An important step in the nursing process is the evaluation of the interventions that have been used so that care plans can be modified.
RESOURCE SPOTLIGHT
Assessing Pain in Persons with Dementia
Try This, a publication of the Hartford Institute for Geriatric Nursing, is a series of assessment tools where each issue focuses on a topic specific to the older adult population. The content orients and encourages all nurses to understand the special needs of older adults and use the highest standards of practice in caring for the elderly.
Each Try This issue is a 2-page document with a description of why the topic is important when caring for older patients on the first page, and an assessment tool that can be administered in 20 minutes or less on the second page. The series is accessible online and also as hard copy.
IN THE NEWS
INFLUENZA VACCINATION AS SECONDARY PREVENTION FOR CARDIOVASCULAR DISEASE
October 2006 -- National Guideline Clearinghouse -- On the basis of clinical evidence, the American Heart Association (AHA) and American College of Cardiology (ACC) recommend inactivated influenza vaccination as a component of secondary prevention for persons with coronary disease and other atherosclerotic vascular conditions (Class I, Level B).
This recommendation is based on the judgment that influenza vaccination should be administered to all persons with cardiovascular disease (unless they have a contraindication to receiving the vaccine).
This science advisory is consistent with the recommendations of the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices. Read more >>
NEW THERAPIES MAY HELP SOME END-STAGE HEART FAILURE PATIENTS AVOID TRANSPLANT
May 7, 2007 -- EurekAlert -- Implanted pumps improved heart function enough in a small percentage of patients awaiting a heart transplant that they were able to leave the hospital without a pump and without a new heart, according to a study in Circulation: Journal of the American Heart Association. The heart-assist devices also significantly improved the cardiac function in many other heart failure patients. Read more >>
OHIO KEPRO EVENTS
THE GOOD APPLES: TIPS FOR ATTRACTING AND RETAINING THE RIGHT EMPLOYEES
In this half-day workshop, we will delve into key strategies for improving workforce retention in the nursing home, including:
- The impact of turnover and absenteeism on an organization and what you can do about it.
- Strategies to improve the hiring and orientation process.
- Motivating employees and improving staff satisfaction.
- Setting goals and measure improvement in workforce retention.
Who should attend: Directors of Operations, Directors of Nursing, Nursing Home Administrators, Staff Development, and Human Resources.
7/11 – Cincinnati | 7/24 – Wooster | |
7/12 – Springfield | 8/7 – Boardman | |
7/17 – Cambridge | 8/15 – Columbus | |
7/19 – Sylvania | 8/21 – Wellston |
Save these dates and register today!
INDUSTRY EVENTS
“The Pain Puzzle” - Ohio Pain Initiative
May 18, 2007, Riverside Hospital, Columbus
30th Annual Nursing Assistant Convention and Recognition Program
June 20, 2007, Akron, OH
Navigating the MDS Through the Ohio Medicaid Reimbursement System
Ohio Department of Job and Family Services
June 11, 2007 or August 23, 2007
Call Cheryl Robertson at (614) 466-9088 for more information.
Medicare Learning Network: Learning resources and products for the healthcare professional.
Alzheimer’s Association Training Events
Case Western Reserve University School of Medicine Courses
Ohio Department of Health, Technical Assistance Program – New Programs
Ohio Health Care Association Events
An archive of The Nursing Home Weekly Update is available on our Web site. Click here >>
