QM's and Pain

Hello. I have the same concern. I work in a LTC facility where there seems to be a much younger population than there was a few years ago and they always seem to have pain no matter what there on. Its usually the younger residents I have the problem with. Meaning, when I ask them "In the past week have you had any pain.? they almost always seem to say yes, its a 9 or 10 , I can't sleep, It hurts to put my shirt on and comb my hair, ect....So then Ill ask if they get relief after taking the pain meds. Agian the answer is usually "no". Most of them tell me the pain is still around 7 or 8. One of the residents is recieving oxycotin ER 10mg BID, Oxycodone 20 mg Q4 PRN, Cymbalta 60mg Q day and valium 2mg TID and according to him before he takes his meds his level is a 10, after he takes his meds his level is a 7 or 8.

So, to try and answer your question, I always write down the answer they give me because the MDS wants to know what there highest level of pain has been in the last week. I then make sure I follow it up with a nurses note Re; his complaints , the meds he was given, the outcome (according to the resident) and I make sure I chart what he did throught the day and that the MD is aware along w what the doctors respons was.. I also make sure the back of the careplan is updated (Despite res. recieving.......he continues to complain of pain, refuses hot/ice packs, refuses therapy,ect) This paticular resident propells himself throught the day w no assistance, goes LOA several times a week and he has been observed getting in and out of his brothers car showing no s/s of and discomfort or pain. I know pain is subjective but this guy is on a lot of meds, NEVER shows s/s of pain, is always going on LOA's. If you could give speeding tickets out for W/C going to fast, this guy would get one every day ! So, when the state comes in and wants to know why so and so has so much pain , all they have to do is read the nsg. notes , MD progress notes (I always ask the MD to write a progress note reguarding the residents complaints of pain ) and review the care plan and I'm sure they will see exactly what we see.... Last year one of the surveyors reviewed this residents chart because of the pain and they said we were doing exactly what we should be doing. Unfortunately updating your care plan and writing good nurses notes wont change your QM ratings, but the charting will at least cover you butt.