Q: Is it required to perform a nutritional, functional, and pain assessment or screen in the Emergency Room, Outpatient Settings and Hospital Owned or Sponsored Physician Office Practices on ALL patients and at ALL encounters?
A: The standards for nutritional functional assessment clearly state that the assessment are performed when warranted by the patient’s needs or condition. The standard for the pain assessment, while stating that it is performed for all patients has long been interpreted to mean “as appropriate to the reason the patient is presenting for care or services” and in the 2004 standards the element of performance will state “A comprehensive pain assessment is conducted as appropriate to the individual’s condition and the scope of care, treatment and services provided”.
It is important to take a realistic approach to an expectation for these three assessments. There are many situations when one or more of the assessments are not warranted. For example”
- the patient presenting to the ER with a laceration would not need a nutritional screen or assessment and a limited functional screen or assessment if the laceration effected their muscles or tendons
- the patient presenting to the ER with a rash would not need a functional or pain assessment or screen and but may need a nutritional assessment to determine the cause of the rash.
- the patient presenting to the ambulatory clinic for weekly allergy injections would not need a nutritional, functional or pain screen or assessment
- patients presenting for outpatient diagnostic procedures such as x-rays or lab draws either would not need the assessments or the assessment would be limited to the impact on the procedures, such as whether they withheld food and fluid prior to the procedure, any pain associated with positioning for the procedure, any functional limitations related to transfer or positioning for the procedure
- emergency situations where the need to stabilize the patient for transfer to surgery or inpatient setting does not allow for or mandate the need for the assessments or screen in the ER
Examples of a situation where the screens would be necessary would include:
- the first time visit for primary care to an ambulatory clinic or office practice. Thereafter, the screens and assessment would be needed only as appropriate to the reason the patient is presenting for care or services.
- the patient with a trauma would be assessed for pain and functional status but most likely not nutritional status
- the patient with chest discomfort would be have a pain assessment and if time allows and cardiac reasons have been ruled out they may receive a nutritional screen as part of the diagnostics, or if the patient is admitted, the nutritional screen and assessment may be deferred to the admission assessment.
As a requirement of the assessment design standard the organization is expected to define in writing the scope of assessments including the data gathered to assess patient needs. Criteria should be defined by the organization in respect to all services and settings. An additional standard requires “A licensed independent practitioner with appropriate clinical privileges determines the scope of assessment and care for patients in need of emergency care”.
As such, it is not required that an assessment of nutritional status, functional status, or pain in all patients at all encounters if it has not been defined by the organization’s policy, a licensed independent practitioner with appropriate clinical privileges has determined that it is not necessary in emergency situations, or it is not warranted by the patient’s needs or condition.