Technical information about the pain quality measure.

September 20, 2009 by admin

Pain can be hard to assess and report, but this is very important to the resident's quality of life. The pain quality measure only identifies residents with pain or suspected to have pain; it does not identify efforts to control the pain. You should use this information when you visit the nursing home. It can be used as a starting point to ask questions about the care given by the nursing home to find and treat pain. When talking broadly, a higher percentage on this quality measure is worse and a lower percentage is better. However, when comparing "Nursing Home A" and "Nursing Home B," this may not be true. Here are two examples of why this may happen:

• Imagine two nursing homes with exactly the same residents and quality of care except for on difference. "Nursing Home A's" staff does an excellent job of checking the residents for pain and "Nursing Home B's" staff does an average job of checking their residents for pain. "Nursing Home A" will have a slightly higher percentage on this quality measure, but is not providing poorer care.
• Imagine two other nursing homes, who also provide identical care and have identical residents except for one feature. "Nursing Home C" has many residents, who for personal or cultural reasons refuse pain medication. "Nursing Home D" does not. "Nursing Home C" will have a slightly higher percentage than "Nursing Home D," but is not providing poorer care.

Resident Choice It is important to know that the resident can refuse to accept pain-control efforts. Some reasons that a resident would refuse pain medication could be that they might be concerned about the possibility of dependency on a particular drug, they don't want to feel groggy, or they don't like to take medicine. In this situation, nursing homes look for ways to treat or lessen pain without the use of medications. Cognitively Impaired Residents (For example: Residents who have Alzheimer's Disease.) Some nursing home residents may be cognitively impaired and are unable to verbalize their pain. With this in mind, it is always a concern that cognitively impaired residents may not be included in the data. This quality measure uses a resident level risk adjustment to allow the cognitively impaired resident to be fairly represented in the data. Long-term vs. Short stay In general, the short-stay populations are likely to report higher percentages of pain because of the types of medical conditions they have. Usually, short-stay patients have injuries or conditions like broken bones or recent surgeries that require short term, aggressive rehabilitation. These conditions usually cause moderate levels of pain or discomfort that should be identified and treated. Aggressive physical rehabilitation itself is also sometimes associated with a certain level of pain that may be unavoidable as the resident works to recover maximum function. Finally, the rates of pain in the short stay resident may appear to be higher than they actually are due to the more frequent assessments over a shorter period of time. MDS coding (For Facility Personnel) MDS 2.0 only captures pain symptoms. The MDS 2.0 does not capture pain management/pain intervention data (except by proxy in some residents, i.e., by capturing the pain became less severe with time or the decreasing frequency). Such documentation would be found elsewhere on the resident's record in the nurses' notes, progress notes, medication records, and care plan. CMS anticipates that few residents on pain management measures will not have some level of breakthrough pain during the 7-day assessment period that should then be coded on the MDS. For example, if through assessment or clinical record review you note that the resident has received pain medications or other pain relief measures, investigate the pain need and capture the pain event on the MDS. However, if the resident does not experience ANY breakthrough pain in the 7-day assessment window, they would indeed code 0. Remember that the assessment covers a 7-day period and should reflect the highest level of pain recorded by any staff member, not just the assessment of the professional completing the MDS.