Joint Commission details new pain assessment, management standards in R³ Report

In late August, The Joint Commission released an R³ Report, also known as the Requirement, Rationale, and Reference Report, on the development of new and revised Joint Commission pain assessment and management standards for hospitals. The standards are the result of an 18-month standards revision project that included a focus on the safe and judicious prescribing of opioids. The project was part of a national effort to address the opioid crisis in the U.S., which is designed to ensure that physicians assess and treat pain appropriately, and that patients have a substantial involvement in pain assessment, treatment, and goal setting and an understanding of the safety issues associated with the use of analgesics of all kinds. Surgeons are, of course, deeply involved in this issue, given that pain is so central to pre- and postoperative patient management.

To develop these new and revised standards, The Joint Commission engaged in the following activities:

• Conducted an extensive literature review, as well as a field review
• Convened a technical advisory panel—composed of members of leading health care organizations—to talk about high-quality and safe initiatives regarding pain assessment and management
• Visited hospitals to research leading practices on pain assessment and management, particularly the safe use of opioids
• Formed a standards review panel to appraise draft standards

Requirements that may affect surgeons

These pain assessment and management standards, which take effect January 1, 2018, are designed to improve the quality and safety of care provided by Joint Commission-accredited hospitals. They require hospitals to make pain assessment and management, as well as safe opioid prescribing, a priority.

What do these standards mean for surgeons? The hospitals where surgeons hold privileges will have to meet new requirements that will affect pre- and postoperative activities. Even if these requirements have no direct effect on surgery, surgeons will want to be fully informed about the standards, which are as follows:

• Leadership 04.03.13—Pain assessment and pain management, including safe opioid prescribing, is identified as an organizational priority for the hospital.
  • Element of performance (EP) 3: The hospital provides staff and licensed independent practitioners (LIPs) with educational resources and programs to improve pain assessment, pain management, and the safe use of opioid medications based on the identified needs of its patient population.
  • EP 4: The hospital provides information to staff and LIPs on available services for consultation and referral of patients with complex pain management needs.
  • EP 6: The hospital facilitates practitioner and pharmacist access to the prescription drug monitoring program databases.
  • EP 7: Hospital leadership works with its clinical staff to identify and acquire the equipment needed to monitor patients who are at high risk for adverse outcomes from opioid treatment.
• Medical Staff 05.01.01—The organized medical staff has a leadership role in the organization performance improvement activities to improve quality of care, treatment, and services and patient safety.
  • EP 18: The medical staff is actively involved in pain assessment, pain management, and safe opioid prescribing through the following activities:
    • Participating in the establishment of protocols and quality metrics
    • Reviewing the performance improvement data
• Provision of Care, Treatment, and Services 01.02.07—The hospital assesses and manages the patient’s pain and minimizes the risks associated with treatment.
  • EP 3: The hospital treats the patient’s pain or refers the patient for treatment.
  • EP 4: The hospital develops a pain treatment plan based on evidence-based practices and the patient’s clinical condition, past medical history, and pain management goals.
  • EP 5: The hospital involves patients in the pain management treatment planning process through the following efforts:
    • Developing realistic expectations and measurable goals that are understood by the patient for the degree, duration, and reduction of pain
    • Discussing the objectives used to evaluate treatment progress (for example, relief of pain and improved physical and psychosocial function)
    • Providing education on pain management, treatment options, and safe use of opioid and nonopioid medications when prescribed
  • EP 6: The hospital monitors patients identified as being high risk for adverse outcomes related to opioid treatment.
  • EP 7: The hospital reassesses and responds to the patient’s pain through the following activities:
    • Evaluation and documentation of response(s) to pain intervention(s)
    • Progress toward pain management goals including functional ability (for example, ability to take a deep breath, turn in bed, and walk with improved pain control)
    • Side effects of treatment
    • Risk factors for adverse events caused by the treatment
  • EP 8: The hospital educates the patient and family on discharge plans related to pain management, including the following:
  • Pain management plan of care
  • Side effects of pain management treatment
  • Activities of daily living, including the home environment, that might exacerbate pain or reduce effectiveness of the pain management plan of care, as well as strategies to address these issues
  • Safe use, storage, and disposal of opioids when prescribed
• Performance Improvement (PI) 01.01.01—The hospital collects data to monitor its performance.
• PI 02.01.01—The hospital compiles and analyzes data.

To view the entire list of pain assessment and management standards, which are available online through the end of the calendar year, visit the Joint Commission’s website. After January 1, 2018, these standards may be accessed in the main Joint Commission manual.

The R³ Report is a Joint Commission publication for accredited organizations and interested health care professionals that details the resources used for development of new requirements. The R³ Report goes into more depth than the main manual, providing a rationale statement for each element of performance. View the R³ Report online.

Disclaimer

The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.