{"ref":"MO-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 and manages pain and other symptoms for every patient: a pain and symptom assessment at every clinical visit with tools suited to the patient, interventions in the plan of care, the medical director's consultation with attending physicians on pain and symptom control, time frames for follow-up when a symptom is not controlled, opioid safety, emergent visits within 90 minutes when clinically indicated, when to consider continuous home care or general inpatient care, and care of the actively dying patient and family. Missouri's hospice rule sets no pain scale or visit frequency, so those are Agency standards.","inShort":["Ask about pain and other symptoms at every visit. Use 0 to 10, or PAINAD or FLACC for patients who cannot tell you.","A score of 4 or more, or above the patient's comfort goal, needs action the same day and a check again within 24 hours.","When clinically indicated, an emergent visit must be made within 90 minutes from the time the need is identified.","If a symptom is not controlled within 48 hours, the medical director consults with the attending physician and the IDG reviews the plan.","Every patient on a scheduled opioid needs a bowel regimen. Watch for sleepiness, confusion and slow breathing.","When a patient is actively dying, increase contact, review medications and teach the family what to expect."],"primaryCitation":"19 CSR 30-35.010(2)(G)2.A","citations":["19 CSR 30-35.010(2)(G)2.A, E","19 CSR 30-35.010(1)(E)2.A-B, D","19 CSR 30-35.010(1)(H)1-3","19 CSR 30-35.010(2)(D)1-6","19 CSR 30-35.010(2)(G)1.C","19 CSR 30-35.010(2)(H)3-4, 7","19 CSR 30-35.010(2)(M)1.B(V)","13 CSR 70-50.010(5)"],"federalCitations":["42 CFR §418.52(c)(1)","42 CFR §418.54(c)","42 CFR §418.56(c)","42 CFR §418.106(a)","42 CFR §418.204(a)","42 CFR §418.302(b)(4)","42 CFR §418.312(b)"],"surveyorAsks":["How do you assess pain in a patient who cannot tell you? Show me the tool and where it is used.","This patient reported severe pain last week. What was done, and when was the pain checked again?"],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (19 CSR 30-35.010(2)(G)2.A; 42 CFR §418.56(c)(1))","5. Assessing Pain and Other Symptoms","6. Assessment Tools","7. Planning and Treatment","8. When a Symptom Is Not Controlled","9. Opioid Safety","10. Higher Levels of Care","11. Care of the Actively Dying Patient","12. Measuring and Improving","13. Responsibilities","14. Records and Compliance Monitoring","15. Staff Training","16. References","17. Related Policies and Forms","18. Approval","19. Revision History"],"version":"1.0","sample":false,"pack":"mo-hospice","state":"Missouri","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}}