Setting Standards for Assessing and Treating Pain

Supporting quality improvement and JCAHO standard setting for pain management in hospitals

Field of Work: Developing accreditation standards for the assessment and treatment of pain.

Problem Synopsis: Data from the RWJF-funded SUPPORT study showed a high incidence of uncontrolled pain in very ill and dying adults (some 74 percent to 95 percent having such pain) in spite of planned interventions from nurses to encourage physicians to attend to pain control. The SUPPORT study investigators concluded that "more proactive and forceful measures may be needed" to improve care of seriously ill and dying patients.

Synopsis of the Work: From 1997 to 2003, a project team at the University of Wisconsin School of Medicine and Public Health worked with the Joint Commission (formerly JCAHO, the accrediting organization for more than 15,000 health care organizations in the United States) on the development of accreditation standards for the assessment and treatment of pain. The team also developed and helped implement quality improvement programs for pain management in home health agencies and hospitals.

Key Results:

  • The Joint Commission approved new standards for the management of pain on July 30, 1999.
  • The project team helped implement pain management quality improvement programs in 52 Wisconsin home health agencies and 233 hospitals nationwide.
  • The project team produced a series of seven videos designed to help health care providers develop key skills in pain assessment and management.

Key Findings: The project team reported:

  • A statistically significant increase in the presence of administrative policies and procedures critical to improving pain management from project start (45% of hospitals) to follow-up (72%).
  • Statistically significant improvements in pain management practices, including documented use of pain rating scales, decreased use of intramuscular opioids and increased use of nonpharmacological strategies such as massage or acupuncture.
  • Patient survey data showed no change in pain outcomes.

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