Publications
APS Bulletin • Volume 10, Number 4, July/August 2000
President’s Message
New JCAHO Standards for Pain Management:
Carpe Diem!
C. Richard Chapman, PhD
The American Pain Society (APS) faces challenges on many fronts. Usually our progress is slow and steady, but now and again we take a giant step. Our current cooperative venture with the Joint Commission on Accreditation of Healthcare Organizations is a major leap forward. Thanks to the tireless work of some of our members, June Dahl, PhD, and Patricia Berry, PhD RN, among them, the Joint Commission has issued new standards expectations for pain assessment and treatment. These standards at last recognize the pressing need for organized pain management programs in hospitals and other types of healthcare organizations. They explicitly recognize pain as a condition that coexists with many diseases and injuries. As such, pain now requires explicit assessment and management. The new standards ensure that pain assessment and management will not muddle along indefinitely as optional features of patient care in the United States. Instead, pain control will become a formally acknowledged patient right and an organizational responsibility.
The enormous change in organizational priorities and practice patterns that the new standards engender is entirely feasible and will succeed. The tools and knowledge that healthcare organizations need to meet the new standards are now, and long have been, available. Moreover, numerous evidence-based and consensus-driven pain management guidelines will facilitate the process of change. The new standards will help healthcare organizations do what they have not done to date: integrate pain management into all patient care activities.
The new standards for pain assessment and management will appear in the 2000–2001 Joint Commission standards manual. To examine these standards in detail or to obtain a copy, go to the Joint Commission’s Web site at http://www.jcaho.org/standard/pm_mpfrm.html. The standards apply to ambulatory care facilities, behavioral healthcare facilities, healthcare networks, home care, hospitals, long-term care organizations, long-term care pharmacies, and managed behavioral healthcare organizations.
In brief, the standards require that healthcare organizations comply with the following:
- Recognize the right of patients to appropriate assessment and management of pain.
- Screen for the existence and assess the nature and intensity of pain in all patients.
- Record the results of the assessment in a way that facilitates regular reassessment and follow-up.
- Determine and ensure staff competency in pain assessment and management, and address pain assessment and management in the orientation of all new staff.
- Establish policies and procedures that support the appropriate prescription or ordering of effective pain medications.
- Educate patients and their families about effective pain management.
- Address patient needs for symptom management in the discharge planning process.
- Maintain a pain control performance improvement plan.
On May 22, 2000, the Joint Commission and APS jointly held the first of two meetings designed to roll out the new standards. The first “Leadership Summit on Pain Management” took place in the Chicago area. Roughly 400 healthcare professionals and administrators attended this meeting. The objectives of the meeting were to
- Showcase the leadership of the Joint Commission and APS in achieving effective pain management in American healthcare institutions.
- Disseminate information to accredited healthcare organizations on the new pain management standards.
- Educate healthcare professionals about pain management guidelines, organizational change strategies, and legal/ ethical issues, and thereby improve assessment and treatment of pain in a wide range of healthcare settings.
- Publicize the urgent need for more aggressive and effective clinical and organizational responses to patients’ acute and chronic pain, and stimulate collaboration between executives and practitioners to address this need.
The program consisted primarily of didactic lectures and panel discussions on barriers to change in pain management, organizational change, the origin and nature of Joint Commission standards, and ethical issues related to pain management. It also included an informative and moving presentation by a patient with rheumatoid arthritis pain, with assistance from her husband. The patient recounted the onset and progression of her painful condition and the difficulties she had in finally finding effective pain management. This story is a classic and highly instructional example of pseudoaddiction.
Participants had an opportunity to comment and to query presenters. Some were concerned about whether a “top down” change could really work. Others contended that issues regarding addiction to pain medication were major and real barriers that the presenters, and the standards, were failing to recognize. Some worried that the new standards would contribute significantly to healthcare costs. A few voiced concern about insurance companies presenting barriers to the intended changes. A psychologist spoke up about the need to integrate cognitive behavioral factors into the issues that the standards raise.
In closing the meeting, I told the audience that we (APS and the Joint Commission) were well aware that they and their colleagues might see these requirements as an onus. In many settings, care providers do not think that pain management is a problem, and they feel ill prepared to undertake formal pain assessment and management. Nonetheless, the standards are an opportunity to make a lasting change in practice patterns that is of great humanitarian value. Moreover, the change will increase patient satisfaction and decrease costs in the long run. Complying with the new Joint Commission standards is not a matter of accommodating bureaucratic imposition; it is a chance to make the world a better place and to prevent future human suffering.
The new Joint Commission standards should concern all of us as APS members. Now, more than ever, healthcare professionals in a wide spectrum of care facilities need guidance and instruction about pain and its management. There is a role for all of us in meeting this need. Basic scientists can teach about the mechanisms of pain and interventions for pain. Nurses, physicians, and pharmacists can educate their peers about pain management. Psychologists should find some unprecedented opportunities to work with mental health professionals in behavioral healthcare organizations. We have an opportunity to create a climate of enthusiastic change, instead of grudging compliance, if we seize the moment and step forward to help.