Get ready for new pain management standards

The Joint Commission on Accreditation of Health care Organizations has developed new standards for pain management. The new standards will be included in the 2000-2001 standards manuals and will first be scored for compliance in 2001. Your facility will be called upon to:

• recognize the right of patients to appropriate assessment and management of pain;

• assess the existence and, if existing, 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.

The new standards explicitly acknowledge that pain is a coexisting condition with a number of diseases and injuries and requires explicit attention. For example, a patient with breast cancer should effectively be treated not only for the actual illness, but also for any associated pain.

Last year, copies of the proposed standards were sent to accredited health care organizations and achieved an approval rating of 92%. Currently, the Joint Commission is working with other organizations to promote effective pain assessment and management. That will include production of an educational video, presentations at national and regional conferences, and educational seminars for accredited organizations. At mid-year 2000, the Joint Commission will assess the ability of accredited organizations to comply with the standards and put into place a plan for full or phased-in implementation.

Consistent assessment is sought

The new standards will ensure that pain in the ED is more consistently assessed and managed, stresses Emory Petrack, MD, MPH, chief of the division of pediatric emergency medicine at Rainbow Babies and Children’s Hospital in Cleveland. "For example, a patient presenting with a laceration or fingertip avulsion will need to have the specifics of pain management addressed, in addition to repair of the injury itself," he explains.

You will need to have a method for documenting and quantifying pain assessment, subsequent management, and the patient’s response, Petrack advises. "To succeed with this goal, an ED policy regarding pain management is essential, and staff will need to be appropriately trained."

The Joint Commission on Accreditation of Health care Organizations, Department of Standards, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5900. Fax: (630) 792-5942. E-mail: Web:

Emory Petrack, MD, MPH, Division of Pediatric Emergency Medicine, Rainbow Babies and Children’s Hospital, 11100 Euclid Ave., Mail Stop MATH6097, Cleveland, OH 44106-6019. Telephone: (216) 844-8716. E-mail: