Hospice Composite Measure: Pain in Verbal, Nonverbal, or Cognitively Impaired Patients Using Hospice Software

▤ Summary

The consequences of inadequate screening, assessment, and treatment for pain include physical and existential suffering, diminished functional status, and development of depression. It is more of a challenge to include all elements of a comprehensive pain assessment in HIS question J0910C for nonverbal patients. The HIS Manual version 2.01 gives examples of a comprehensive pain assessment for a nonverbal patient that are an excellent teaching resource for clinicians. An assessment that includes what relieves or worsens pain for a nonverbal patient may include documentation about activities or positions that relieve or worsen pain, such as “patient exhibits increased nonverbal signs of pain when sitting in chair.” An assessment that includes pain’s effect on function or quality of life for a nonverbal patient may include documentation about change in patient activity, such as “caregiver reports that patient is no longer able to sit up in chair without bracing and guarding.” If you ask a family or caregiver about any of the aspects of the comprehensive pain assessment and the family/caregiver does not know the answer, mark that you assessed these areas, and include documentation in your narrative that you asked these questions and indicate the lack of response. It is important to document the attempt in the hospice software to gather the information and take credit for your work.

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