Pain and Symptom Management and Care of the Actively Dying Patient

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.

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About this policy

Policy number: MO-HSP-PAIN-01
Version: 1.0
Main rule: 19 CSR 30-35.010(2)(G)2.A
Library: Missouri hospice · 59 policies
Category: Hospice care
Sections: 20

In short

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.

What's inside

20 sections. The full text comes with the One-time Policy Pack.

Full text with a package

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

An inspector may ask

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?

Missouri hospice

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Rules it follows

19 CSR 30-35.010(2)(G)2.A19 CSR 30-35.010(2)(G)2.A, E19 CSR 30-35.010(1)(E)2.A-B, D19 CSR 30-35.010(1)(H)1-319 CSR 30-35.010(2)(D)1-619 CSR 30-35.010(2)(G)1.C19 CSR 30-35.010(2)(H)3-4, 719 CSR 30-35.010(2)(M)1.B(V)13 CSR 70-50.010(5)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)

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