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

Managing Your Patients’ Pain: It’s Not Just about the Opioids

Before Pain Assessment Was the Norm

Some of the most difficult times I experienced as a nurse involved patients in pain. This was before the days of patient-controlled analgesia, when patients in acute pain were mostly managed with “Demerol IM q4h.”

I recall many incidents of paging and telephoning and beeping physicians and residents to get orders for pain medications and trying whatever non-pharma methods I could think of to allay pain. It was awful to see patients suffer needlessly.

Progress, But with a Cost

Then pain became a key part of assessment, as well as of patient satisfaction scoring, and clinicians heeded the need for managing pain. However, there has been too much reliance on the quick fix of strong opioids. A friend who recently had surgery was asked by a nurse to rate his pain. When he replied “eight,” she asked him if he wanted one or two oxycodone pills. His reply, “Well, what do people usually take?”

Revising the Approach to Pain Management

Thankfully, pain management is being revisited, and along with a renewed focus on not prescribing by the numbers (a patient’s pain rating should only be one factor in deciding the intervention), there is a greater understanding of pain and how it can become chronic, and there are more modalities at our disposal to manage it.

To prevent acute pain from […]

Appropriate Use of Opioids in the Management of Chronic Pain

Painted by Martin Edwards as part of the Paint Your Pain program initiated by the Pain Management Center at Overlook Medical Center, Atlantic Health System, Summit, New Jersey. For artwork of other patients in the program, go to http://bit.ly/ 1Ns0PxL.The dangerous misuse of prescription opioids and drugs like heroin has been much in the news, but millions of patients continue to suffer both acute and chronic pain. For many, prescription opioids play a vital role in alleviating that pain. How can health care providers most effectively and safely use opioids in the treatment and management of chronic pain? Some answers can be found in a CE article in the July issue of AJN: “Appropriate Use of Opioids in Managing Chronic Pain.”

Related questions on opioids and chronic pain addressed in the article include:

  • What is the best way to assess chronic pain patients?
  • Which patients—for example the elderly, those with compromised renal or hepatic function, those with a history of substance abuse—may require special considerations when opioids are prescribed?
  • Which opioid medication or medications, if any, should you select for your patient?
  • And what are the legal and practical challenges to prescribing opioids?

[…]

2016-11-21T13:01:03+00:00 July 22nd, 2016|Nursing, pain management, patient safety|0 Comments

AJN in July: Opioids and Chronic Pain, Moral Distress, Prediabetes, More

CE Feature: Appropriate Use of Opioids in Managing Chronic Pain.”

Unintentional death related to prescription opioids has been identified as a public health crisis, owing in part to such factors as insufficient professional training and medication overprescription, misuse, and diversion. The authors discuss current best practices for prescribing opioids for chronic pain, emphasizing patient assessment and essential patient teaching points regarding safe medication use, storage, and disposal, and after you find a more permanent solution people could totally quit opioids by using a detox methods that goes from medicine to even a detox tea like leptinteatox. There are some medicines or supplements that are more easy to use, depending on the problem, like the peruvian brew, that helps with erectile dysfunction and is pretty safe. After that you only need to be careful with stds diseases you can go and test at https://www.stdaware.com/chlamydia-test.

CE Feature: “Moral Distress: A Catalyst in Building Moral Resilience.”

Moral distress is a pervasive problem in nursing: an inability to act in alignment with one’s moral values is detrimental not only to the nurse’s well-being but also to patient care and clinical practice as a whole. Moral distress […]

Recent Decline in U.S. Opioid Prescriptions: Good News But Some Concerns

by frankieleon/ via flickr by frankieleon/ via flickr

It was widely reported in the past week that there have been steady declines in the number of opioid prescriptions in the U.S. for the past three years, with the declines the steepest in some of the states considered to have the worst opioid misuse crises.

This is good news, suggesting that efforts to address some problem areas like renegade pain clinics prescribing for profit, patients who go from doctor to doctor seeking opioid prescriptions, and the diversion of legitimate opioid prescriptions may be starting to bear fruit.

A balanced overview of the situation can be found in this New York Times article. The authors also acknowledge that patients in pain are now facing new hurdles to pain relief, quoting the director of one prominent medical school’s program on pain research education and policy: “The climate has definitely shifted. . . . It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”

Much of the reporting on the opioid epidemic lumps all people who take opioids into one big statistical brew. While startling and alarming numbers about overdoses from legal and illegal opioids steal the headlines, little media and scholarly analysis focuses on the lower likelihood of opioid misuse or overdose seen in […]