JCAHO Pain Management Standards Take Effect Jan. 1

Under new Joint Commission on Accreditation of Healthcare Organizations standards effective Jan. 1, hospitals must implement new accreditation standards mandating that providers monitor and treat pain in a "state-of-the-art" fashion from the moment a patient is admitted, the Associated Press reports. Upon admission, patients will be asked to rate their pain levels on a scale from zero to 10, the latter being the "worst pain imaginable." Children will use pictures to indicate the intensity of their pain (Neergaard, Associated Press, 12/25). In August 1999, JCAHO the developed the standards to improve assessment and management of pain at health care facilities. While the standards are included in the 2000-01 standards manuals, hospital compliance will be rated beginning 2001 (American Health Line, 8/6/99). To stress the importance of the new regulations, the standards "actually put in writing that 'patients have the right' to proper pain assessment and treatment." Any JCAHO-accredited-facility, including hospitals, outpatient clinics and nursing homes, must adhere to the new standards in order to retain its accreditation (Associated Press, 12/25).

Costly Oversight
Pain resulting in medical bills and lost work days is estimated to cost $100 billion per year in the United States. In addition, research from the American Pain Society has shown that when left untreated, acute pain may become chronic pain. But according to JCAHO President Dr. Dennis O'Leary, many doctors receive "little training in pain management." He added, "You pick your pet pain medicines that work for you. You don't bother to learn about the interplay of these medications with others, nor about other modalities." Indeed, surveys have indicated that pain rated high on JCAHO's scale of zero to 10 is "consistently reduced to 3 or 2" when hospitals use the pain relief standards. But the standards face "formidable barriers," as many health care workers "erroneously believe" that treating pain can get patients addicted to drugs (Tarkan, New York Times, 12/26). Providers avoid many opioids, or narcotic painkillers, including morphine, codeine and fentanyl, because they fear the potential for patient addiction and abuse. American Pain Society president-elect Christine Miaskowski said, however, that for people who have "never abused drugs ... hardly any[one] become[s] dependent on pain medicine." Noting that unrelieved pain has negative effects, she said, "Patients are going to have to demand better care. ... Just like they need an antibiotic to treat infection, they need analgesics to treat their pain." Given that hospitals currently are "scrambling" to meet compliance, Miaskowski added, "This is not going to happen overnight" (Neergaard, Associated Press, 12/25).