Quality of Care

F697 — Pain Management

Failure to provide care and services to manage residents' pain in a manner that addresses the resident's individual goals and preferences for pain management.

Reg cite · 42 CFR 483.25(k) 89 surveys in corpus 20 states

What surveyors look for

  1. Pain assessment on admission, with each new pain complaint, before and after PRN analgesics, and during quarterly reviews
  2. Pain scale appropriate to the resident (NRS, FLACC, PAINAD for dementia)
  3. Documentation of effectiveness within 1 hour of administration; alternative interventions if ineffective
  4. Non-pharmacological measures (positioning, heat/cold, distraction) before and alongside PRN opioids

Common gotchas

  1. PRN pain meds given without pre-pain score documentation
  2. Pain assessed only at vital sign timepoints, not when resident expresses pain
  3. Dementia residents charted at pain score 0 across the entire admission
  4. No follow-up assessment after PRN administration

Real survey examples

From CMS-published 2567s in our corpus. Resident identifiers redacted.

AL SEV D — 2023-06-19
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide safe, appropriate pain management for a resident who requires such services. Based on resident record review, interviews, and review of the facility guidelines for Pain Management, the facility failed to ensure nursing staff sought an order for treatment for ice therapy for one (Resident) of one residents reviewed for concerns of pain. Findings included: A review of a facility guideline titled, Pain Management, dated January 2021, revealed the purpose was To provide guidelines for consistent evaluation, …
AL SEV D — 2023-06-19
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a phone interview on [date] at 2:42 PM, Registered Nurse (RN) #26 stated she did not remember Resident. She said if ice therapy were ordered, she would provide it. She said if a patient asked for ice therapy and did not have an order for it, she would have sought an order for it. During an interview on [date] at 1:52 PM, Licensed Practical Nurse (LPN) #4 stated residents required an order for ice therapy. She said if Resident asked for ice therapy at night, an order could have been sought for it that nigh…
AK SEV D — 2025-05-09
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide safe, appropriate pain management for a resident who requires such services. . Based on record review and interview, the facility failed to ensure that residents who received opioid pain medications (a class of strong pain-relieving medications that act on the nervous system, with potential for dependence, overdose, and serious side effects) were re-evaluated for pain for 11 residents (#1, #2, #6, #12, #20, #24, #26, #37, #49, #51, and #259), out of 53 residents reviewed for pain management. Specificall…
AK SEV D — 2025-05-09
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident Record review on 5/5-9/25 revealed Resident was admitted to the facility with diagnoses that included peripheral vascular disease (narrowing of blood vessels outside of the heart and brain, causing poor circulation), heart failure, and anemia. Review of Resident's eMAR and clinical progress notes revealed the Resident received an opioid pain medication: .Tylenol-Codeine #3 300mg-30 mg tablet.PRN (as needed) for DJD [degenerative joint disease] knee pain, from [date] through [date]. Further review revea…
AK SEV D — 2025-05-09
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident's eMAR and clinical progress notes revealed the Resident received an opioid pain medication: .Oxycodone 5 mg tablet.as needed for pain, from [date] through [date]. Further review revealed seven instances in which opioid medications were administered, but no documentation of pain reassessment was found within 30 to 60 minutes following administration. Resident Record review on 5/5-9/25 revealed Resident was admitted to the facility with diagnoses that included cellulitis (a bacterial skin infe…

Accepted POC examples

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Related F-tags

F684 F744

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