SDS Pain Management-JCAHO adds pain management standards

The Oakbrook, IL-based Joint Commission on Accreditation of Healthcare Organizations has developed pain management standards that require same-day surgery programs to recognize pain management as part of the patient's treatment and demonstrate that a process is in place to help patients manage pain. (See standards, p. 4.)

"Pain is more than an unpleasant sensation," says June L. Dahl, PhD, professor of pharmacology at the University of Wisconsin-Madison Medical School. "Scientific studies document that untreated pain delays recovery," she says.1 "On the other hand, acute pain that is treated aggressively results in a faster recovery and fewer complications."

The importance of the Joint Commission standards is that all academic and professional efforts to increase awareness of the undertreatment of pain may have increased awareness but have not changed clinical practice in many cases, says Dahl. "There are studies that show that at least 45% of surgery patients report an inadequate treatment of pain," she adds.2 Requiring a process to ensure that patients receive pain management information and support can affect actual practice, she adds.

Although the new pain management standards are included in the 2000-2001 Joint Commission standards manuals, the standards will not be scored for compliance until 2001, says Susie McBeth, associate director of the standards department for the Joint Commission.

"Surveyors are scoring the standards in order to collect feedback and check the readiness of the field," says McBeth. The surveyors also use a questionnaire that collects information related to how an organization is already managing the pain management process and collecting information that can be used to document compliance. The data collected will show how much documentation already exists that will meet the Joint Commission needs and how much needs to be created, she explains.

"One of the issues raised early on in the development of the standards was that we didn't want to burden the organization with the creation of a lot of new documentation," she says.

In July 2000, the data collected by the surveyors and the scores of organizations surveyed during the testing period will be reviewed by the standards committee, which will determine how to weight each standard.

McBeth offers these tips to help ensure compliance:

Read the standards in light of the scope of your services. "Don't create elaborate protocols and documentation processes if your program can't handle them," McBeth advises. Instead, look at what you already have in place and enhance or alter it to meet the requirements. For example, make sure you have a place to document assessment of pain or referral for treatment of pain, she says.

Set up a good pain assessment process. "Assessment will be key whether you treat the pain yourself or refer to another provider to treat pain," she says. Your assessment process must show that you check the patient's pain status and provide relief, whether it is by administering medication within a recovery room setting or referral to a physician after hours, she says.

Develop a thorough education process. "Make sure your staff know how to teach patients to manage pain and use pain medications," she says.


1. Wattwill M. Postoperative pain relief and gastrointestinal motility. Acta Chiurgica Scandinavica 1988; 550:140-145.

2. Donovan M, Dillon P, McGuire L. Incidence and characteristics of medical pain in a sample of medical surgical inpatients. Pain 1987; 30:69-78.

For more information about Joint Commission pain standards, contact:

Joint Commission on Accreditation of Healthcare Organizations Interpretation Unit. Telephone: (630) 792-5900. Web site: www.

June L. Dahl, PhD, Professor of Pharmacology, University of Wisconsin-Madison Medical School, 1300 University Ave., Room 4715, Madison, WI 53706. E-mail: jldahl@facstaff.