Long-Term Care Survey Alert

The buck stops with the medical director for ensuring resident comfort.

Your facility will end up saddled with F501 tags if the medical director doesn't ride herd on attending physicians who refuse to get with the facility's pain management program.

The typical F501 deficiency: "A typical F501 deficiency ties into another deficiency, such as inadequate pain control ...," says Karl Steinberg, MD, CMD, a medical director in Oceanside, CA. The deficiency will say that the medical director failed to coordinate care in the facility, he notes.

Nurses represent the first line of defense in ensuring the resident receives proper pain management. Nurses need "to learn to articulate to the physician why the team believes a patient is in pain and what the team recommends instead of accepting the physician's refusal to treat the pain adequately," advises Cheryl Boldt, RN, who provides training on pain management. "Nurses have to get back on the horse and ride again to get the message across ... so the patient gets effective pain intervention," says Boldt, a consultant in Omaha, NE.

Don't stop there: If the attending refuses to change course for a resident with poorly managed pain, the nurse should let the medical director know, says Steinberg. "The nurse has to rely on her own nursing judgment to say, 'This patient is suffering and we need to try something different, or an increased dose,' etc.," he says. In such cases, "the medical director can call the attending and discuss the situation," Steinberg says.

"If the attending doesn't feel comfortable ordering the type or amount of pain medication required, then the medical director can offer to see the patient and order the medication himself," says Steinberg. "In any event, the facility has the responsibility to ensure every resident receives adequate pain medication," emphasizes Steinberg. "In some unusual cases, this may mean having to transfer the resident to a higher level of care such as the acute hospital."