Nursing Home Quality Improvement Initiative

Quality Measure Fact Sheet:
Percent of Chronic/Long Term Care Residents who had
Moderate to Severe Pain

Why residents may have pain even with good care:
Pain always has underlying causes, which may not always be curable in frail elderly patients. Some pain is difficult to treat and complicated by other medical conditions such as depression. Pain medication given to some residents, especially those who are on several other medications, may cause them to become confused, stop eating, or fall.

Residents can refuse to accept pain medications due to unwarranted fears of becoming dependent upon the drug(s), or due to not wanting to feel sleepy or groggy. Other pain relief techniques, such as the exercise of an affected muscle or joint, repositioning, or the application of heat or cold locally, may be used (alone or in combination with appropriate pain medications), but may be refused due to temporary increases in pain.

Situations where residents may be counted in this measure even with good care may include the following:

• Residents may refuse pain relief or may choose partial pain relief to avoid excessive sedation or other unpleasant medication side effects.
• Residents have conditions such as advanced arthritis or cancer associated with frequent or unpredictable pain, that may not be readily relieved by any known medications or approaches. The goals for such situations may be simply to reduce the pain's intensity or frequency, but not necessarily eliminate it. In spite of treatment, these residents may have daily moderate pain.
• Residents may have "phantom" pain, such as feeling pain in a limb that has been amputated. While this type of pain is treatable, results are often suboptimal.

Some long term care facilities may do a better job of assessing residents for pain. A higher percent of residents with pain may simply indicate that the facility is doing a better job of assessing residents for pain.

What conditions exclude a resident from this measure: (Risk adjustment)
No conditions are excluded from this measure.

Questions you can ask the facility if they are rated high in this measure: What signs and symptoms suggest to the facility that a resident may be in pain, and how often do they monitor for pain? How does the facility identify causes of pain, and how does it determine whether the cause can or cannot be corrected? Other than ordering pain medications, what treatments are used to relieve pain? What does the facility do if a patient refuses medication treatment for pain? How does the facility monitor the effectiveness and risk to benefit of pain intervention?