Ensure all individual members of multidisciplinary teams work toward a common goal to ensure patients’ pain lessens throughout the episode.
When team members move in various individual directions to address pain, this decreases the chances that the patient’s pain will be lessened or eliminated by the end of the episode and beyond. Improving your agency’s results on pain can help with its scores on Home Health Compare, 5-star ratings and value based purchasing.
At many agencies, employees don’t communicate well and the patient feels like the right hand doesn’t know what the left is doing.
To resolve this issue and achieve the best results on M1242 (Pain interfering with activity), the entire multidisciplinary team must have frequent, open communication and discuss team strategies.
During the conversations, it’s possible that one multidisciplinary team member might identify pain issues that can best be addressed by another discipline.
Open communication can occur with the help of electronic medical record (EMR) notes, conference calls with the team, voicemails set up for the multidisciplinary team and, of course, face-to-face meetings. Detailed EMR notes will ensure there is good documentation in the clinical record, which is important in order to show compliance of coordination of care in the legal clinical record. (See an example of a clinician’s thorough, detailed note at http://bit.ly/2ibym2Y.)
It is essential that necessary documentation such as follow-up assessments be shared among team members, but it’s also important that relevant information in visit notes, orders and reports be made available.
Don’t Overlook Aides, Contractors
When thinking about the importance of communication among multi-disciplinary team members, don’t forget about home health aides. They often spend the most time with the patient and understand what the triggers are for the patient’s pain — such as if there are side effects of the pain medications.
Also, don’t overlook contracted services. These service members are a big part of the team if, for example, they provide therapy for the patients.
In fact, the revised Home Health Conditions of Participation (CoPs), which largely take effect Jan. 13, 2018, enforce the fact that the aide and contracted services are a part of the interdisciplinary team.
The newly released draft interpretive guidelines for the CoPs state for §484.80(g)(4) that during interdisciplinary team meetings, all agency staff involved in the patient’s care must be present for and contribute to the discussion.
The aide is allowed to participate in person, electronically or by phone.
Ensure Effective Pain Management
- Have every clinician perform a thorough pain assessment during every visit. During an initial pain assessment, ask the patient to describe past and current experiences with pain including: effectiveness of the methods used to manage the pain, both pharmacologic and non-pharmacologic; experiences with side effects and interactions; typical coping responses while having pain and what is effective; and what, if any, concerns the patient has about pain.
When documenting each pain assessment, the clinician should address pain characteristics including the onset, duration and location.
Detail where the pain is located, as well as associated symptoms. List factors that help alleviate or exacerbate pain. And explain the patient’s functional abilities with and without pain.
Within documentation, indicate why pain is high or low. For example, did the patient forget to take her pain medication?
- Ensure that coordination of care is continuous. This way the team can determine what kinds of treatment are effective and ineffective. Some patients, for example, might like meditation or music therapy while others might not.
Don’t wait until the agency’s overall case conference to discuss strategies to eliminate or reduce a patient’s pain. The team must talk whenever there is any issue or change, the patient isn’t making progress, or the patient has achieved a goal.
This should never occur less than weekly, but it can occur more often than that. It can even be something as short as documenting: “The patient’s hip pain was at 7 today. The patient stopped taking her pain medication due to wooziness. The physician was notified and ordered a new pain med. The patient will begin taking it tonight, and teaching about the possible side effects was completed. PT will evaluate in the a.m. to see if the medication was effective.”
Note that the multidisciplinary team’s communication needs to be even more responsive if the patient’s pain issues are more urgent.
- Include the physician(s) in discussions about pain. Talk about what the multi-disciplinary team recommends, and communicate frequently with the physician if interventions are ineffective.
Many teams don’t include the physician in discussions frequently enough.
The RN or therapist should communicate with the physician for status reports and requests of additional options for pain management treatment or to find pain medications and doses appropriate for the patient.
Among the other options available to help with pain: Ice, heat and ultrasound machines. The physician also might approve of music therapy or meditation, for example.
Communications with the physician not only should be placed into physician orders and visit note documentation, but also must be communicated to the team in real time.
If you would like to discuss how we can assist you with the team approach to pain management, please feel free to contact us at [email protected] or 866-428-4040.
Source: Home Health Line, Decision Health, December 4, 2017