F697 Pain Management Updates: What SNFs Need to Know
Managing pain effectively isn’t just about comfort — it’s a core component of quality care and compliance in post-acute care environments. The Centers for Medicare & Medicaid Services (CMS) recently updated F697 Pain Management guidance, and these changes are now impacting how facilities assess, treat, and monitor pain across all resident populations. Here’s a quick breakdown of the most important updates and what they mean for your nursing teams:
Focus on Person-Centered & Proactive Pain Care
CMS expects facilities to:
- Recognize pain early — including non-verbal signs in cognitively impaired residents
- Use validated tools consistently
- Prioritize resident voice and preferences
- Update care plans immediately when pain changes
Translation? Pain should never go unnoticed or unaddressed.
New Emphasis on Safe Opioid Use
A major addition to F697 is stronger guidance around opioid prescribing and monitoring:
✔ Immediate-release opioids should be considered first when starting therapy
✔ Residents must be informed of risks and benefits
✔ Ongoing monitoring should be provided for:
- Sedation
- Respiratory depression
- Constipation
- Potential misuse or diversion
✔ Interdisciplinary (IDT) oversight is required
✔ Documentation must clearly support the clinical need and outcomes
CMS wants facilities to balance effective pain relief with safe prescribing practices.
Non-Pharmacologic Interventions Matter More Than Ever
CMS expects facilities to show consistent use of alternatives such as:
- Positioning
- Heat/cold therapy
- Massage
- Activity & movement
- Music & relaxation techniques
These aren’t just “nice to have” — they must be documented as part of the care plan.
Documentation = Your Strongest Defense
Surveyors will focus on:
- Timely reassessment after medication (within 60 minutes for acute PRN meds)
- Care plans that evolve with resident needs
- Evidence that pain is managed, monitored, and modified when needed
CMS reinforces: If it’s not documented… it didn’t happen.
QAPI: Better Outcomes through Data Driven Practice
Facilities should be auditing pain management trends routinely, including:
- Reassessment compliance
- Opioid safety monitoring
- Non-pharmacologic use
- Resident satisfaction and functional outcomes
This isn’t just paperwork — it’s quality of life.
CMS has made it clear:
Pain management must be individualized, evidence-based, and consistently documented.
Facilities that strengthen their processes now will set the standard for resident comfort and survey success.
Need Support Rolling Out These Updates?
Proactive assists facilities with Policy and EMR workflow update, training, QAPI audit tools and monitoring programs, and Implementation support with documentation compliance checks
Contact us for help preparing your team or reviewing your current processes.
Written By:
Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CPC, CLNC
Director of Regulatory Services
Proactive LTC Consulting
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