New Standards for Pain Management in Hospital Patients
Effective on January 1, 2001, new standards require that the pain suffered by patients in hospitals be measured regularly from the time they check in, and that patients be given proper pain relief or the hospitals risk losing their accreditation.
Interview with June Dahl, Professor, University of Wisconsin Medical School
Standards were approved a year and a half ago and the results will be released next week to appropriately manage pain for patients. Patients have a right to pain management and pain management is a part of treatment. Patients should expect and demand pain control. This applies to post-op pain, procedural pain, pain in ambulatory care and home health pain. To make sure that this is implemented, pain will be assessed in all patients. There are a number of ways to assess pain: the number one way is to ask the patient to rate their pain intensity and how it feels. When someone enters a hospital starting January 1, 2001, they should know that the hospital they are in is supposed to ask them about this.
If the hospitals aren't doing this, they can lose their accreditation. There isn't any evidence that health care professionals are deliberately letting people suffer, but people haven't been routinely asked about their pain in the past. If the patient is a child or can't express their pain, doctors should use pictures to help them express their level of pain. This demands that health care professionals know their patients and their movement. If the patient is unable to speak, then its up to the health care provider to determine levels of pains by the patients movements or actions.
For example, when people are in extreme pain they tend to curl themselves into a fetal position. It's important for patients to remember that pain has adverse consequences on the healing process and can be harmful to the body. A lot of patients fear that they will become addicted to medicine and they don't talk openly about their pain, but they should know that their pain can and should be relieved.
Background Information
Many hospital patients suffer every day from pain that is ignored or under-treated by doctors and caregivers. The new standards will require hospitals, nursing homes and outpatient clinics to measure every patient's pain regularly from the time they check in. Some hospitals are already handing out leaflets and posting signs telling patients of the new rules. Patients should expect to be asked to rate how they're feeling on a scale of zero to ten--from no pain to the worst pain imaginable. Small children will use pictures to rate their pain. The score determines what steps the hospital should take to help. ©MMII CBS Worldwide Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed
Patients should expect at least to be asked to rate how they're feeling, from zero--no pain, to 10--the worst pain imaginable. The score determines what steps the hospital must take t help. To stress how important the changes are, the new standards actually put in writing that "patients have the right" to proper pain assessment and treatment. Hospitals aren't the only ones that must take the new steps, but nursing homes and outpatient clinics accredited by the Joint Commission on Accreditation of Healthcare Organizations must measure pain as well.
The commission adopted the standards over a year ago, but gave facilities until January 2001 to comply. However, teaching health workers who aren't pain specialists how to treat pain can take some time, and many doctors inappropriately shun narcotics--a treatment mainstay for numerous types of pain, because they think patients will get hooked on them.
Many patients don't realize that pain actually hinders healing. Patients need to know that revealing how much pain you're in doesn't "bother the doctors" or distract them from treating your underlying disease. Cancer patients provide the best estimates: About 40% of ancer patients have under-treated pain. One in four elderly cancer patients in nursing homes receive no treatment at all for daily pain.
About nine percent of Americans suffer chronic pain, ranging from back injuries to rheumatoid arthritis. Experts say four of every 10 with moderate to severe pain don't get adequate relief. One of the biggest challenges is teaching non-specialists that narcotic painkillers called opioids such as morphine, codeine, fentanyl, are the mainstay for many types of pain. Many doctors hesitate to prescribe opioids, which are heavily regulated because addicts may abuse them. But for patients who have never abused drugs and have no history of psychological problems, very few become dependent on pain medicine.
Another complaint about the use of painkillers is heavy sedation, which usually wanes in three to four days. For moderate to severe pain from acute illness or surgery, expect a short-acting opioid like Percocet, or morphine in a patient-controlled quick-dose pump. For cancer, expect a long-acting version of morphine or oxycodone, or a fentanyl skin patch. For chronic pain not due to cancer, new guidelines recommend similar opioids. Methadone is an alternative when those drugs fail. Doctors also are trying antidepressants and antiseizure drugs like gabapentin for patients with nerve-related pain. And relaxation and hypnosis help, too, but shouldn't replace proper medication.List of the new pain standards that health care organizations need to follow: