Pain-Free Hospital

Problem:

Despite efforts to bring about more effective pain management, surveys continue to demonstrate a high prevalence of pain in hospitalized patients. Physiological, psychological, ethical, and financial consequences result from under-managed pain.

Background:

The Agency for Health care Policy and Research (AHCPR) examined this issue in the document 'Clinical Practice Guidelines for Acte Pain Management: Operative or medical Procedures and Trauma.' This publication had the goals of (a) reducing the incidence and severity of acute postoperative or posttraumatic pain, (b) educating patients about how to communicate unrelieved pain, and (c) enhancing patient comfort and satisfaction, decreasing postoperative complications, and reducing length of stay.

The American Pain Society (APS) also emphasized the need to assess outcome variables, including patient satisfaction with staff response to the reports of pain, and satisfaction with relief provided. Their guideline calls for pain to bed recognized and treated promptly. Pain intensity is to be assessed and documented using a simple, valid measure upon initial evaluation of the patient, after pain-producing procedures, after interventions to decrease pain and at regular intervals.

Hospital accreditation have established standards for pain management in hospitals. The JCAHO standards (2001) were prompted by an increased awareness of the amount of untreated pain hospitalized patients endure, and required regular measurement and recording of pain in the inpatient setting. Specifically, the standards stated that patients have the right to appropriate assessment and management of pain, and called for initial and regular reassessment of pain; education of care providers in pain assessment and management; education of patients and families; and "after taking into account personal, cultural, spiritual and/or ethnic beliefs, communicating to patients and families that pain management is an important part of care."

JCI Standard AOP:1.7 requires that all inpatients and outpatients are screened for pain and assessed when pain is present. It has 3 Measurable Elements:

1. Patients are screened for pain
2. When pain is identified, the patient is referred or a comprehensive assessment is performed, appropriate to the patient's age and measuring pain intensity and quality such as pain character, frequency, location, and duration.
3. The assessment is recorded in a way that facilitates regular reassessment and follow-up according to criteria developed by the organization and the patient's needs.

Status in CCH:

A collaborative and interdisciplinary approach to pain control is necessary to comprehensive care, which includes assessment and frequent reassessment of pain, pharmacologic and nonpharmacologic methods to control and/or prevent pain, and evaluation of outcomes. No universal institution-wide method for accomplishing this assessment and documentation existed at CCH until our first JCI accreditation (2008).

Design (elaborate):

1. Chronic pain, including cancer clinics; specialized anesthesia treatment
2. Inpatient
3. Outpatient
4. Pediatric

References:

1. Acute Pain Management Guideline Panel. Acute pain management in adults: operative or medical procedures and trauma: clinical practice guideline. Agency for Health Care Policy and Research (AHCPR) publication no. 92-0032. Rockvill, MD: AHCPR, Public Health Service, U.S. Department of Health and Human Services, 1992.
2. American Pain Society Quality of Care Committee. Quality improvement for the treatment of acute pain and cancer pain. JAMA 1995;274:1874-1880.