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Pain Reassessments-They're a Pain

Accreditation Monthly, May 13, 2008

This month's article was written by Bud Pate, REHS, and Lisa Eddy, RN, CPHQ, senior consultants at The Greeley Company.

The Greeley Company is receiving more requests for assistance with post Joint Commission accreditation survey clarification work. One of the most frequent requirements for improvement is  for pain reassessments. Many hospitals are cited for failure to conduct a reassessment after pain intervention. However, it isn’t that organizations aren’t reassessing pain, it’s that they aren’t documenting the pain reassessment.

Follow your policy
This core issue is emerging as one of policy versus practice. The Joint Commission (formerly JCAHO) rightly will cite a hospital for failure to reassess the patient’s pain in accordance with the hospital’s own policy. It is not uncommon for hospitals to “hold their own feet to the fire” by an overly stringent pain management policy that requires reassessment of pain post-intervention in an unrealistic time period. The Joint Commission under the “Provision of Care” chapter, standard PC.8.10 elements of performance (EP) 3 requires regular reassessment according to hospital-established criteria. There is no hard and fast Joint Commission rule for pain reassessments. These can be done as the hospital defines.

Make your policy realistic
We suggest you revise your policy to align with real-life practice and not put difficult-to-accomplish time frames in your policy for pain reassessment. For example, it is almost impossible for a busy med-surg nurse caring for multiple patients with complex needs, to reassess a pain medication administered intravenously and then document that reassessment within 20 minutes, as some polices require. We suggest a more flexible approach that moves the nurse toward the bedside and away from superfluous documentation. For example, rather than requiring pain reassessments concurrently, why not require a pain reassessment for the presence and intensity of pain at least once every 12 hours for inpatients and extended-stay outpatients and following any intervention intended to lessen the patient’s pain (e.g., administration of pain medications, application of cold packs, repositioning). Reassessment (post-intervention) should take place within a clinically appropriate time frame, such as within a one-to two hour time frame for the administration of oral medications or within one hour of the administration of intramuscular or IV pain medications.

Educate your patients
But don’t forget your pain policy must be complemented by a plan for ongoing pain education (which is required under RI.2.160 EP.1). It is this education document that will specify the how to complete clinically appropriate reassessments.

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