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.
When it comes to opioid administration within the acute care setting, I have noticed several concerning behaviors with nurses and physicians, alike. On several occasions, I have witnessed a nurse refusing to give opioids for pain management with the mindset that the patient may be seeking “The High” and/or the time frame from when the last dose was administered may not meet the drug order parameters. The patient may not have been administered the full dose or the patients subjective pain level may be disregarded by the nurse. In reference to physicians, I have noticed that some avoid giving any prescription, or order, for opioids. I do understand that there are patients who may fabricate what they’re feeling for the sake of receiving opioid medications, though, in my field of practice, the vast majority of the patient population are in severe pain. I currently work in an acute Critical Care setting and the majority of my patients are truly experiencing high levels of acute pain. Some nurses come from other practices where they were accustomed to the type of patient who are opioid-seekers. I believe that nurses and physicians must be given further education regarding this issue.
Morphine is a narcotic drug used all over the hospital to treat patients with moderate to severe pain. The drug is also known for its high risk for addiction and dependence as it can cause respiratory distress and even death if its abused with other substances or taking in high doses. The information stated above is very informative. It gives a clear example of a patients’ family members concern. As the son being her protector, he is uncomfortable with her receiving morphine for her end of life care. Hospice is to keep the patient comfortable and although morphine can cause respiratory distress and may lead to death, I think in this case the benefits outweigh the risk. The patient and family were appropriately educated on the administration and side effects of morphine. The priority to end of life care is to keep the patient comfortable. I work in labor and delivery, which is the complete opposite to end of life care, but ironically, beginning of life is also very painful and we too, need to keep our patients comfortable. We provide epidurals for our laboring patients with high doses of pain medication because pain management is a priority on our unit. With the proper education and administration pain medication is beneficial to patients weather its end of life or beginning of life care.
I have serious concerns about the over reaction to the opioid crisis. While I know that there are significant problems in the drug abuse by certain individuals, there is the concern whereby physicians and facilities have moved to the extreme in refusing to prescribe ANY opioids regardless of the intensity of the patient’s actual pain. Case in point… a family member of mine underwent a major bowel surgery at a hospital in the state of Pennsylvania in November 2018. The medications that were given were Tylenol And an anti inflammatory agent. For a period of three days she suffered pain that was far beyond what a patient should have to endure. The physician absolutely refused to provide any type of narcotic medication even though she begged for something to minimize this pain. When the family contacted me I recommended that they contact the Chief of surgery and the hospital administrator. As well, I contacted the Pa. state board of medical policy and oversight . After all of the meetings and complaints , on day 4 she was finally given appropriate medication to alleviate the terrible pain that she had endured since the day of surgery. This is not an isolated case. I worked at a major university associated facility for many years and saw a number of patient’s admitted with liver failure due to an overdose of Tylenol in cases where they had dental surgery or another procedure in which the physician told them to ‘just take some Tylenol’ . Naturally when they got very minimal pain relief they simply took more and more Tylenol , never realizing how dangerous it was.
There needs to be much greater sensitivity to a pt’s Pain with clear guidelines as to when a pt should be treated with opioid medications and when not to treat with such. Either way a pt should not have to endure what they consider to be unbearable pain in this current day of medical miracles,
Off-message comment: Would love to connect with commenter Suzanne Misenhimer re: same last name spelled the same way & apparently we are both nurses. Appreciate any suggestions to help connect. And thank you for the blog.
Joint Commission is way, way behind in addressing the addiction problems that they primarily played a role in creating.
Our huge gap in this plan is the lack of resources in terms of treatment plans. Now if JCAHO could only mandate THAT.
The Joint Comission is one of the main groups who supported pain as the fifth vital sign and advocated for opiate prescription. I hope that they are owning their part in the current opioid crisis.
Of all the new guidelines enacted by the Joint Commission, the “PDMP” database is seemingly most effective in dealing with this complex issue. As a nurse at a very busy emergency room, I see an immense amount of patients that are most likely addicted to opioid analgesics. Some of these patients have become so creative and resourceful when attempting to gain access to these medications that it becomes almost impossible to ascertain who is having a pain crisis and who is just there for the high. I’ve seen everything from someone rolling on the ground begging for “just a milligram”, to patients getting downright aggressive with hospital staff and doctors. Having a database that is accessible by all hospital facilities that tracks opioid administration and prescription would be massively advantageous. I applaud the Joint Commission for taking a realistic look into the emerging opioid crisis in modern health care facilities and I look forward to a brighter future in pain management.