{"ref":"CA-HSP-PAIN-01","title":"Pain and Symptom Management and Care of the Actively Dying Patient","category":"Hospice care","summary":"Sets out how the Agency assesses, treats and reassesses pain and other symptoms, the plan of care content California requires, how sudden increases in pain and uncontrolled symptoms are escalated (significant change within 24 hours, the two-hour in-person response, continuous home care or inpatient care), safe opioid use, palliative sedation, and care of the patient who is actively dying and the family.","inShort":["Ask about pain and other symptoms at every visit and call, and record the score.","Use the same pain scale each time. For a patient who cannot speak, use a behavioral scale.","Check whether an as-needed dose worked and write down the result.","A sudden increase in pain must reach the physician as soon as possible within 24 hours. Call the registered nurse right away.","If a family reports uncontrolled pain, a nurse must be there in person within two hours."],"primaryCitation":"22 CCR §74868(c)(7)","citations":["22 CCR §74864(b)(2)(D)-(E)","22 CCR §74868(c)(6), (7), (15)","22 CCR §74868(h), (i)(1)(D)","22 CCR §74820(a)","22 CCR §74820(b)","22 CCR §74892(k)(5)","Cal. Health & Safety Code §1746(d)(4), (h)","Cal. Health & Safety Code §124961","22 CCR §74892(s)","Cal. Health & Safety Code §1746(j)"],"federalCitations":["42 CFR §418.52(c)(1)","42 CFR §418.56(c)(1)"],"surveyorAsks":["Show me how this patient's pain was assessed at the last three visits, and what was done when it was not controlled.","Where in the plan of care is the prescribed method of pain management?"],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (Health & Safety Code §1746(d)(4); 22 CCR §74868(c)(6)-(7); 42 CFR §418.52(c)(1))","5. Assessment","6. Planning and Treatment","7. Common Symptoms","8. Reassessment and Escalation","9. Safe Use of Opioids and Sedatives","10. Palliative Sedation","11. Care of the Patient Who Is Actively Dying","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"ca-hospice","state":"California","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}