JCAHO’s new standards inspire patient pain guide

GA agency puts pain management on fast track

Advantage Home Health in Savannah, GA, has wasted no time in revising the way staff assess and help manage patients’ problems with pain.

The new pain management standards, added to the accreditation manual for home care by the Joint Commission on Accreditation of Healthcare Organizations of Oakbrook Terrace, IL, call pain assessment the "fifth vital sign." Advantage Home Health now requires nurses and therapists to assess patient pain at every visit, says Deborah Jennings, RN, quality manager/coordinator of the agency, which serves six counties in coastal Georgia.

"I think the nurses see the sense in the requirement," she says. "They said that many times before; they would ask patients about pain, but didn’t document it if patients say they don’t have any pain."

Now, they must document the patient’s response to a pain scale of 0-10 with 0 representing no pain, and 10 representing the worst pain imaginable. Staff enter the pain rating in their laptop computers.

The agency also has a new patient teaching guide on pain management. It’s placed in patients’ admission packets and handed out to each patient. (See Advantage’s patient teaching on pain management, p. 78 and above.)

Other changes included holding a 40-minute inservice for nurses and therapists on pain management and the Joint Commission standards.

"We went over the pain management tool and how you use it and when you use it," she says.

There was no inservice for home health aides because they are required only to report when patients say they are experiencing pain, and that requirement has not changed.

Jennings made changes to two agency tools that will help her monitor how well the staff are doing with pain management and assessment. The first change was to the agency’s admission audit form. She added an item: "Pain is assessed & documented?"

Chart auditors will check nursing documentation to make sure that they have assessed patients’ pain properly. If the first audits turn up problems, Jennings says she might add another and more specific pain assessment indicator to the audit tool.

The second change was to the patient satisfaction tool and the patient satisfaction telephone surveys. The customer satisfaction survey now has a question that asks, "Did we help with your pain control?" The same question is asked during the random telephone surveys conducted of discharged patients, Jennings says.

Deborah Jennings, RN, Quality Manager/Coordinator, Advantage Home Health, P.O. Box 24177, Savannah, GA 31403. Telephone: (912) 692-7543. Fax: (912) 692-5882.