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New pain assessment and management standards instituted by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) will become a part of surveys conducted this year, and could be part of the Joint Commis-sion scores for hospitals and other agencies beginning in 2001.
The standards, which have been endorsed by the American Pain Society, call for the following additions to the JCAHO accreditation manual for hospitals. They include:
• Requiring hospitals to include a commitment to pain management in their mission statements, patient bill of rights, or service standards. One implementation example included in the manual is a statement posted in patient care areas in a community hospital. The statement informs patients that they have a right to information about pain and pain relief measures. It tells patients they can expect quick response to reports of pain, state-of-the-art pain management, and that "your reports of pain will be believed."
The notice also lists patient responsibilities, including communicating with doctors and nurses about pain, response to pain relief, and any concerns a patient may have about taking pain medication.
• Provisions for assessment and management of pain of all patients. This would include an initial assessment, periodic reassessment, and post-procedure monitoring.
Examples of implementing that standard could include recording pain intensity readings during admissions, asking screening questions regarding pain, and evaluating competency in pain assessment during staff orientation.
• Addressing the appropriate use of patient-controlled analgesia, spinal/epidural, or IV administration of medications and other pain management techniques, through policies, staff orientation, or other means.
• Addressing pain and pain relief in patient and caregiver education. Examples offered include publications that stress pain management and review of computer-generated information sheets that are distributed with medication.
Susie McBeth, JCAHO’s associate director, department of standards, says the pain management additions stemmed from a concern that patients’ pain continues to be undertreated. "We had standards in the manual that really related more to the dying patient, even though it was implied that all patients should really have good pain management."
She adds the standard regarding pain assessment is key to proper pain care."Really listening to the patient is the important part of it," McBeth says. "You really need to listen to the patient and don’t bring your own bias into it about how much pain you think that patient is feeling."
JCAHO to offer resources
Surveyors will be asking about pain management during surveys conducted in 2000, but scores from those standards won’t affect accreditation. McBeth says JCAHO will use the information as feedback to determine how much weight the standards will carry in 2001. "This is the year for people to implement the standards and get ready, and we just want to kind of see where everybody is."
In the meantime, the Joint Commission will try to assist in the education process this year by offering publications, two pain management "summits" tentatively scheduled for May and July, an educational video, and other programs.
The commission is also seeking information from hospitals that have developed successful pain management programs, to use as case studies. For more information, write the Joint Commission on Accreditation of Healthcare Organizations at One Renaissance Boulevard, Oakbrook Terrace, IL 60181-4294. Telephone: (630) 792-5000. Web site: www.jcaho.org.