Table 1.

CPPI Practice Indicators: Abbreviated and Detailed Descriptions

Abbreviated Description	CPPI Indicator Detailed Description
1. Valid pain scale use at admission	Pain assessment completed using a valid culturally sensitive pain scale (numeric scale, verbal descriptor scale, faces scale) for patients able to report pain OR using a non-verbal pain scale &/OR pain behaviors documented for patients with a cognitive impairment at hospice admission. (Culturally sensitive= translated pain scale &/or interpreter services used.)
2. Comprehensive assessment-primary	Patients with pain present at admission with primary components of Comprehensive Pain Assessment completed within 24 hours of admission (pain intensity; pain location; pain quality; pain duration/pattern; impact of pain on function).
3. Comprehensive assessment-other	Patients with pain present at admission with additional components of Comprehensive Pain Assessment completed within 48 hours of admission (detailed pain history including description of previous & current pain episodes & treatment effectiveness; physical exam, including musculoskeletal & neurological assessment; presence or absence of delirium; things that make pain better; things that make pain worse; presence of anxiety and depression).
4. Pain Intensity reassessment for moderate or severe pain (5 or >)	Reports of moderate/severe (5 or >) pain followed by pain intensity assessment within 24 hours.
5. Increases in pain medications for consecutive reports of pain intensity 5 or greater	Consecutive pain intensity reports of 5 or greater that are followed by increases of opioid dose or additional analgesic added within 24 hours.
6. Order for pain medication with admission pain report	Pts with admission report of pain as mild (1–4) with order for nonopioid or combination of opioid-nonopioid analgesic within 24 hours of admission OR Patients with admission report of pain as moderate (5–6) or greater with order for opioid analgesic within 24 hours of admission OR Patients unable to self report with pain behaviors documented with an order for a non-opioid or opioid analgesic within 24 hours of admission.
7. Bowel regimen initiated	Patients with an opioid order that have an existing bowel regimen (includes both laxative and stool softener) in place or a new order for a bowel regimen initiated within 24 hours of an opioid order.
8. Analgesic side effects monitored	Patients with opioids ordered who are monitored each day a focused assessment is completed for the five most concerning analgesic-induced side effects (respiratory depression, sedation, nausea and vomiting, constipation, and delirium).
9. Non-pharmacologic therapies used	Patients with report of pain with any cognitive/behavioral non-pharmacologic therapies documented in the following week (e.g., meditation, music, prayer, aromatherapy, imagery) OR any physical non-pharmacologic therapies documented in the following week (e.g., massage, vibrations, lotions: Ben Gay®, Icy Hot®, repositioning, use of hot, use of cold).
10. Review of the Pain Treatment Plan	Focused pain assessments that include a review of the Pain Treatment Plan. Review of Pain Treatment Plan is defined as: documentation regarding the current treatment approaches and maintaining or changing orders, etc., if patient is following the plan and/or degree of adherence to the pain treatment plan.
11. Written pain management plan	Patients with documentation of a written pain management plan that includes ALL the following components: (the causes of their pain, the types of and rationale for their analgesic meds, specific instructions on how to dose and titrate their analgesic meds, instructions on how to manage analgesic side effects, instructions for storage and safe keeping of medications, whom to call if pain is not relieved or increases in intensity or if side effects occur, when & how to use non-pharmacological approaches to pain management).