{"ref":"DC-HSP-PAIN-01","title":"Pain and Symptom Management and Care of the Actively Dying Patient","category":"Clinical tasks","summary":"Sets how the Agency meets each patient’s right to effective pain management and symptom control: assessing pain and other symptoms with standard tools, planning interventions in the plan of care, treating and reassessing, escalating a symptom crisis through the on-call system to continuous home care or general inpatient care, palliative sedation as a last resort, and caring for the actively dying patient and the family.","inShort":["Every patient has the right to effective pain and symptom control. Ask about pain at every visit.","Use the 0 to 10 scale, or a behavior scale such as PAINAD if the patient cannot tell you.","Check within 1 hour whether a breakthrough dose worked, and record it.","If pain stays above the patient’s goal twice in a row, call the physician the same day.","Teach families to call us day or night on (202) 555-0199 for new or worse symptoms.","Aides: tell the nurse during the visit if the patient grimaces, moans or is restless."],"primaryCitation":"42 CFR §418.52(c)(1)","citations":["D.C. Code §21-2221.05(e)","D.C. Code §21-2221.07","29 DCMR §939.20(e)","29 DCMR §939.20(g)"],"federalCitations":["42 CFR §418.52(c)(1)","42 CFR §418.54(c)(4)-(5)","42 CFR §418.56(c)(1)","42 CFR §418.100(a)","42 CFR §418.202(e)","42 CFR §418.204(a)","42 U.S.C. §14402(b)(4)","42 CFR §418.64(a)(3)","42 CFR §418.3"],"surveyorAsks":["How do you assess pain in a patient who cannot tell you about it?","Show me how the plan of care for this patient addresses pain and each other distressing symptom."],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.52(c)(1))","5. Assessing Pain and Symptoms","6. Planning Care","7. Treating and Reassessing","8. Symptom Crises and Escalation","9. Medication That May Shorten Life and Palliative Sedation","10. Care of the Actively Dying Patient","11. Responsibilities","12. Records and Compliance Monitoring","13. Staff Training","14. References","15. Related Policies and Forms","16. Approval","17. Revision History"],"version":"1.0","sample":false,"pack":"dc-hospice","state":"Washington, DC","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}}