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Ensure compliance with new JCAHO standards
With a survey of the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations scheduled for April 2001, staff education on pain management became a high priority at Mercy Hospital in Iowa City, IA.
That’s because this year, compliance with the Joint Commission’s new pain standards will be assessed.
Therefore, a pain assessment workgroup was assembled to create a staff education program that would bring everyone up to speed on how pain is addressed throughout the organization. "My role was in determining resources and the outline for the program," says Mary McCarthy, RN, C, CDE, BSN, patient education coordinator at Mercy Hospital. Other group members were from home health, inpatient and outpatient areas, and pharmacy.
The one-hour training sessions took place in January with makeup sessions in February. They consisted of a brief pain management history that included mention of the efforts of the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, which created clinical practice guidelines on pain. Also discussed was media coverage of pain management within health care settings so that staff would be aware of the information consumers received.
Training tailored to organization’s policies
Curriculum includes what the hospital has in place systemwide. "We adopted a zero to 10 pain scale in the mid-1990s after a workgroup looked at the [AHRQ] clinical practice guidelines on pain," says McCarthy. In 1998, the health care facility also included in its policy the use of alternative comfort measures for pain, such as relaxation methods and music. This occurred when it looked at its policies and procedures on pain in preparation for a survey by the Chicago-based American College of Surgeons.
"We also talk about barriers to assessment for pain, and have a handout on cultural differences and how to evaluate the cognitively impaired patient," she says. Age-appropriate resources for patient education are discussed, as are all the various forms for the documentation of pain assessment and management.
During the training session, staff view a 16-minute video, "Pain Management: The 5th Vital Sign," produced by Envision Inc. in Nashville, TN. (For information on this resource and others, please refer to the end of this article.)
Class participants then are invited to play a game. The game, based on a popular TV show, is titled "Who Wants to be the Millionaire of Pain Management." Contestants are given a question with four possible answers; and once during their turn, they can call a friend (who is someone attending the class), ask the audience, or have two of the wrong answers removed just like the TV version.
One of the simpler questions is: "A reliable indicator of the patient’s pain is: A. the patient’s vital signs; B. what the patient’s wife says; C. the patient’s report of pain; or D. the physician’s progress notes." (Answer: C)
"This is a housewide program, so we made it global. We also wanted people to know that pain is being addressed throughout the organization," says McCarthy.
The approach to staff training taken by the New Mexico Veterans Affairs (VA) Health Care System in Albuquerque is slightly different, however. We went with a department-based rather than systemwide approach, says Carol Maller, MS, RN, CHES, patient education coordinator. For example, instruction on pain management for health care providers was incorporated into grand rounds, and a weeklong pain seminar is now an annual event. During this year’s seminar, in order to help meet Joint Commission pain management standards, the chief medical officer canceled clinics for an hour every morning so that providers would be relieved of patient care responsibilities and could attend. Experts in pain management from around the nation were the scheduled speakers.
In an effort to aid the health care institutions within the VA system, a national coordinating committee for pain management strategies was created. One workgroup within the committee created a resource manual titled "Pain as the 5th Vital Sign Toolkit," for use by Veterans Health Administration managers and staff.
The toolkit offers guidelines for the completion of comprehensive pain assessments, and content includes the following sections:
• Barriers to pain screening and assessment — this section covers barriers for practitioners, patients, and the health care system.
• The pain screening process — this section describes use of the numeric pain scale, provides answers to questions patients frequently asked, and discusses when to screen, document, and interpret pain scores.
• Comprehensive pain assessment — this is a comprehensive "how-to" guide featuring interview suggestions and documentation.
• Education and resource information — this section includes policy, contact persons within the VA, samples for electronic and paper documentation, pain assessment tools, and templates.
• Related JCAHO standards — the American Pain Society based in Glenview, IL, first proposed pain as the fifth vital sign, says Maller. The Depart-ment of Veteran Affairs embraced that proposal and mandated the assessment of pain as the fifth vital sign in March 1999.
In addition to the toolkit, the committee groups helped create many tools for staff education, including a Microsoft PowerPoint program and discussion guide on basic pain management, and a pharmacy Internet education series.
Complying with the Joint Commission’s pain management standards is a large endeavor, says Maller. "It has to be integrated throughout the entire medical center. I have a policy for my patient education program at the medical center, and I have to revise it so it includes pain management. It has to appear everywhere." n
For more information on educating staff about pain management, contact:
• Carol Maller, MS, RN, CHES, Patient Education Coordinator, New Mexico VA Health Care System, 1501 San Pedro Drive S.E., Albuquerque, NM 87108. Telephone: (505) 265-1711, ext. 4656. Fax: (505) 256-2870. E-mail: Carol.Maller@med.va.gov.
• Mary McCarthy, RN, C, CDE, BSN, Patient Education Coordinator, Mercy Hospital, 500 E. Market St., Iowa City, IA 52245. Telephone: (319) 339-3662. E-mail: email@example.com.
Resources for staff education:
• Pain as the 5th Vital Sign Toolkit. To review a copy of the booklet produced by the Department of Veterans Affairs, visit the Internet site. Web: www.va.gov/OAA/docs/residentresources/Pain5thVitalSign/PainToolkit_Oct2000.doc.
• Pain Management: The 5th Vital Sign. This 16-minute video is produced by Envision Inc., 1111 16th Ave. S., Nashville, TN 37212. Telephone: (615) 321-5066. Fax: (615) 321-5119. The staff education video and an accompanying patient education version are sold as a package along with a self-learning packet. The cost is $450, plus $13 shipping and handling. For a free preview of the video, call Envision or visit their Web site: www.envisioninc.net.