need help

[ianadie]

My administrator, myself and the other MDS coordinator are trying to figure out why we score way higher than other area nursing homes for pain with our short stay and long term folks. This shows up on the CMS star rating web site. We know that we are medicating our residents for pain when needed. We are wondering if it has to do with the actual MDS pain interview process and how it is interpreted. How do other facilities conduct their interviews? Are they conducted by a nurse or social worker. We have a designated lay person who conducts all the interviews and enters the results directly to the MDS. She reports her findings to the nursing staff. We are really trying to figure this out and any feedback would be greatly appreciated.

:)

[ibtootie]

My facility has the same issue. When we get post-op patients or patients with infected wounds, I would expect that a resident will say they are having severe pain or 8 out of 10. The problem is that the section J does not permit any inclusion of responses to their pain management. Our facility documents the pain number before the pain medication/intervention, and then documents the number afterward and there is a drastic reduction in the pain number response, but I don't feel like that is being captured in the rather black and white responses to choose from in the assessment.

[Talino]

See the attached on how pain is calculated --

• short-term stay - pp 13-14/61
  
• long-term stay - pp 22/61
  

10 Ways to Improve Your Pain Quality Measure Score

MDS 3.0 Quality Measures User's Manual (Draft).PDF

[PsychNurseWannaBe, BSN, RN]

Why do you have a layperson do your pain ASSESSMENTS. This is to be done by the nurse in my opinion. I talk to all my residents about pain. If pain is not d/t an acute issue, then we might have a pain management problem which our facility tracks monthly. If we can't get the pain in control, they go on report for pain monitoring with updates to the MD until it corrects itself with either a work up or change in pain medications.

It would be easier for the nurse to care plan pain issues, if they were the original one to speak with the resident. ALL residents should have pain monitoring done daily if they are on a schedule pain medication.

[ianadie]

Thanks for everyone's input. To clarify, we do pain screening daily on all of our residents to see if they have any pain, if so pain meds are given. The pain interview for the MDS 3.0 is done at the same time as all the other interviews and again, this is done by a non-nursing person. If a resident does indeed complain of pain during the nterview process it is entered on the MDS as recorded which in turn impacts the QI numbers. We are wondering if other facilities somehow interpret the pain interview differently or are doing something different with the information. Thanks again for any insight into this.

[ibtootie]

Thanks Talino for the link. Still though, if you adhere to the script of the patient interview, it still seems to ask one sided questions. "Have you had ANY pain or hurting over the last 5 days?" yes or no. "Please rate your WORST pain over the last 5 days". There is no question to rate their pain after the pain intervention which could bring their pain relief score to a 1 or 2. Most of our patients are post-operative ortho and they do have frequent pain at a 7-10, but their response to the pain interventions arent captured when sticking to script.