{"ref":"TX-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, plans for, treats and reassesses pain and other distressing symptoms, how symptom crises are escalated, and how the team cares for a patient who is actively dying and supports the family at the bedside.","inShort":["Ask about pain and other symptoms at every visit and use the same rating scale each time.","For a patient who cannot tell you, watch for signs of pain using the PAINAD or FLACC tool.","If a symptom is above the patient’s comfort goal and the orders are not enough, call the prescriber before you leave.","Follow up on a new treatment for pain or a distressing symptom no later than the next day.","Tell families to call (512) 555-0199 at any hour. Continuous care or inpatient care is available for a crisis.","When death is near, visit more often, explain what to expect, and keep the patient comfortable."],"primaryCitation":"42 CFR §418.52(c)(1)","citations":["26 TAC §558.821(d)(1)-(4)","26 TAC §558.811(c)(4)-(5)","26 TAC §558.281(12)","26 TAC §558.850(d)","26 TAC §558.2(83)"],"federalCitations":["42 CFR §418.52(c)(1)","42 CFR §418.56(c)(1)","42 CFR §418.54(c)(4)-(5)","42 CFR §418.204(a)","42 CFR §418.202(e)","42 CFR §418.3"],"surveyorAsks":["How do you assess pain in a patient who cannot tell you about it?","Show me the pain and symptom interventions in this patient’s plan of care and how you know they are working."],"forms":[],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (26 TAC §558.821(d)(1); 42 CFR §418.52(c)(1), §418.56(c)(1))","5. Assessing Pain and Symptoms","6. Planning Care","7. Treating and Reassessing","8. Symptom Crises and Escalation","9. Care of the Actively Dying Patient","10. Palliative Sedation","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":"tx-hospice","state":"Texas","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 Hospice","legalName":"Sample Hospice, LLC","logo":null}}