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Do you know what the JCAHO expects from pain assessments?

Accreditation Connection, December 17, 2004

Expect JCAHO surveyors to take a closer look at how and when your caregivers assess pain. The accreditor already expects you to treat pain as the fifth vital sign by regularly assessing and reassessing a patient's pain. Soon, it may also require you to collect core measure data about it.

The JCAHO has partnered with the American Medical Association and the National Committee for Quality Assurance to create a common set of pain management performance measures. The move is consistent with a recommendation earlier this year from the National Quality Forum, which urged the healthcare industry to develop pain assessment and management measures.
 
Eventually, the JCAHO will make pain management a core measure that will require manual data abstraction from patient charts, predicts Robert Marder, MD, practice director of quality and patient safety for The Greeley Company, a division of HCPro Inc., in Marblehead, MA.

"My guess is that they'll focus on whether patients achieve an 'acceptable' level of pain," says Marder. "A lot of providers now are focusing on establishing a patient's tolerable level for pain, but how many are asking the patient what their acceptable level of pain is? If you establish [his or her] baseline level of what is acceptable, then you've got a more accurate pain assessment."

Although pain is the leading cause of adult disability in the United States, it's vastly undertreated, according to the American Pharmacists Association. "Pain management is a gauge of how well we are treating patients," says Marsha Lynn, PharmD, MS, pharmacist clinical specialist at John D. Dingell Veterans Affairs Medical Center in Detroit.

The JCAHO instituted its pain management standards in January 2001 to help improve patient care. They require hospitals to assess pain in all patients. "They don't just want you to find out how the patient's pain is when they first come in," says Sheryl J. Blecker, RHIA, CHP, chief privacy officer at Maryland General Hospital (MGH) in Baltimore. She noted a JCAHO surveyor's close attention to MGH's pain assessments during a survey earlier this year.

"[Surveyors] want to know: If the patient rates his pain a five and receives medication, when is the next assessment? If the patient is assessed for pain in the ED and then transferred to a unit, is he or she reassessed upon arrival in the unit? Is the pain continuously monitored?" Blecker says.

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