A Closer Look at the Joint Commission’s New Guidelines for Pain Assessment and Management

Photo © Burger / Phanie / Science Photo Library.

Starting on January 1, 2018, the Joint Commission’s new and revised pain assessment and management standards for accredited hospitals will go into effect. Notably, the guidelines—as we report in a November news article—address safe opioid prescribing practices.

Among new requirements, the Joint Commission says hospitals should:

  • Designate a leader or team responsible for pain management and safe opioid prescribing.
  • Include patients in developing a pain management treatment plan—including realistic expectations and measurable goals—and educate them on discharge plans related to opioid adverse effects and safe use, storage, and disposal of opioids.
  • Use prescription drug monitoring program (PDMP) databases to identify patients at risk for opioid addiction.
  • Identify opioid addiction treatment programs for patient referrals.
  • Inform staff about consultation and referral services available for patients with complex pain management needs.
  • Collect and analyze data on pain assessment and management to identify areas in which safety and quality could be improved.

The full list of new and revised guidelines is available here. How might these changes affect life for nurses and patients? Comments are welcome below.

2017-11-17T08:48:30+00:00 November 17th, 2017|Nursing, pain management, patient experience|0 Comments

‘Micro’ and ‘Macro’ Strategies for Nursing to Thrive as a Profession

At last month’s annual convention of the Academy of Medical-Surgical Nurses (AMSN), nurse and health care economist Peter Buerhaus received the Anthony J. Jannetti Award “for extraordinary contributions to health care.” Buerhaus, a professor of nursing at Montana State University College of Nursing, is widely known across health care disciplines for his research on health care costs and value, especially in regard to nurses and nursing. In his keynote talk, Buerhaus shared some of his recent research findings and offered some “micro” and “macro” nursing strategies for thriving amid today’s health care challenges.

Nurses maintain status as highly trusted professionals.

Click to expand. Most trusted professions, Gallup 2017 poll.

He began by reminding the group of some of the reasons that nurses are respected and trusted in America. People believe that nurses ensure quality of care, protect patients and maintain safety standards, and provide advice on personal health issues.

Studies show that we maintain this trusted status even when the media reports on the mistakes of individual nurses. And after good media attention, as when Alex Wubbels protected her patient or when nurses play key roles in disaster relief efforts, our approval ratings soar.

Accomplishments of NPs have reinforced good reputation of nurses.

2017-11-17T10:20:27+00:00 November 15th, 2017|Nursing, nursing research|0 Comments

Brain Injury. Undocumented Patient. Who Decides About Treatment?

When an unauthorized immigrant suffers a brain injury, who decides when treatment is withdrawn? An ethical dilemma touches on issues of clinician autonomy and justice versus patient and family autonomy.

© Photolibrary Wales/ Albany Stock Photo.

Imagine that someone you love—a young person—suddenly collapses and is rushed to the hospital. Her heart is restarted, but it soon becomes apparent that there has been extensive anoxic brain injury. In a vegetative state, on a ventilator, no ability to follow commands, spastic extremities, an EEG showing continuous seizure activity. . . . and this person is an undocumented immigrant. And uninsured.

In this month’s AJN, Kimberly Radtke and Marianne Matzo present a fictional case (based on their real-life experience in palliative care) to illustrate the ways in which this kind of scenario might play out. The parents are overwhelmed, trying to make decisions while they are still in shock. Physicians soon express their concerns about prolonging “medically inappropriate care.” And who will pay for it?

In addition, hospitalization due to critical illness increases an unauthorized immigrant’s risk of repatriation without their consent. What must the family be feeling as they struggle to understand their daughter’s future?

The role of the ethics committee.

Radtke and Matzo discuss the many ethical dilemmas that are raised by this […]

2017-11-17T15:19:22+00:00 November 13th, 2017|Ethics, Nursing|0 Comments

Are There Veterans Among Your Patients?

When vets get non-VHA health care, some issues may be missed.

Most U.S. veterans—and in 2014, there were approximately 19.3 million—do not get their health care from the Veterans Health Administration (VHA). Overburdened facilities with long waiting times and the fact that many veterans live considerable distance from a VHA facility mean that many get their health care from local and private organizations.

And while this may mean more convenient and timely care, it also might mean that health issues related to their military service might be missed by providers who do not have experience providing care to service members and veterans.

This Saturday, November 11, marks another Veterans Day. It’s been our tradition to include content related to health care for veterans or active duty military in November. This year, we have an original research CE article, “Primary Care Providers and Screening for Military Service and PTSD.”

Few providers screen for military service.

The authors of this article sought to examine whether non-VHA primary care providers were screening patients for military service and PTSD. Based on their survey of providers in western Pennsylvania, they found that most did not ask patients about a history of military service—and of those providers who did, few screened patients for PTSD. […]

‘An Urgent Public Health Challenge’ – APHA Meeting Emphasizes Climate Change

APHA climate change/health infographic. Click to enlarge.

The theme of this year’s American Public Health Association (APHA) meeting in Atlanta is “Creating the Healthiest Nation: Climate Changes Health.” The meeting is estimated to have drawn 12,000 attendees. Below are highlights so far.

Threats and opportunities.

Monday night, Howard Frumkin, DrPH, MPH, MD, of the University of Washington, called climate change “one of the most pressing public health issues we face.” In discussing the recently released Lancet Countdown on Health and Climate Change 2017 Report: U.S. Briefing, a joint publication of the Lancet and APHA that highlights the threats and opportunities climate change poses to Americans, Frumkin identified some key findings:

  • Exposure to dangerous heat and severe weather events is increasing.
  • Exposure to disease and allergies is changing (one example: allergy seasons are often prolonged).
  • The carbon intensity of U.S. energy use is decreasing, but this process must be accelerated to reduce climate-related health risks.

Nurse voices in environmental health.

During a session called “Public Health Nursing Research—Climate, Health, and Vulnerable Populations,” Linda A. McCauley, PhD, RN, FAAN, of Emory University, highlighted the vital role nurses play both in producing research findings about environmental hazards and human health and in translating these into practice.

“Nurses can go to the science and take it back to the community. That’s what we’re so good at.”

But when it comes to speaking out about environmental issues and nursing research, she observed, “I don’t think we’ve harnessed […]

2017-11-08T10:31:59+00:00 November 8th, 2017|environmental health, Nursing|0 Comments