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«October 2000 Revised Edition Geriatrics and Extended Care Strategic Healthcare Group National Pain Management Coordinating Committee Veterans Health ...»

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Syrjala, K.L., & Chapko, M.E. (1995). Evidence for a biopsychosocial model of cancer treatment-related pain. Pain, 61, 69-79.

Turk, D.C., & Okifuji, A. (1999). Assessing the patients’ reporting of pain: an integrated perspective. The Lancet, 353, 1784-1788.

Ward, S.E., Goldberg, N., Miller-McCauley, V., Mueller, C., Nolan, A., Pawlik-Plank, D., Robbins, A., Stormoen, D., & Weissman, D.E. (1993). Patient-related barriers to management of cancer pain. Pain, 52, 319-324.

Weissman, D.E., & Dahl, J.L. (1995). Update on the cancer pain role model education program.

Journal of Pain and Symptom Management, 10, 292-297.

Other resources Gordon, D., Dahl, J., Stevenson, K. (Eds.). (1996). Building an institutional commitment to pain management: The Wisconsin resource manual for improvement. Wisconsin Cancer Pain Initiative, University of Wisconsin-Madison, UW Board of Regents. Note: This how-to resource manual provides a comprehensive plan and practical tools for implementing institutional changes in pain management. Available from the Wisconsin Cancer Pain Initiative, 608-262-0978.

Program Guide 1140.10 Hospice Program, Chapter 3: Pain Management, September 13, 1996, Department of Veterans Affairs, Geriatrics & Extended Care Strategic Healthcare Group, Washington, DC 20420.

Hagan, Susan, Chapter 7: Measurement of pain outcomes assessment. Jacobs M.D., Nelson A.L., Berrio, M.W., editors. Measurement tools to support outcomes evaluation. Veterans Health Administration, Nursing Research Constituency Center, December 1998.


Pain as the 5th Vital Sign Toolkit Page 48 Pendergrass, Susan., Paice, J., (ED) (2000) Pain Management. CD-ROM with contact hours for ANCC. Graphic Education Corporation. 903 Old Highway 63, Columbia, MO 65201. (888Includes site license to network. (Available in all VA Libraries.) Sierzant, T., Bauman, P., Belgrade, M., Cook, M., Shephers, M., Regness, E., and Hogan Miller, E. (2000) Pain Management: An interactive CD-ROM for clinical staff development. Aspen Publishers, Inc. 200 Orchard Ridge Dr., Gaithersburg, MD 20878. Customer Service 1-800Available in all VA libraries.) Weavers, Simon (Ed.). (1999). Pain management patient education manual. Aspen Publishers, Inc. 200 Orchard Ridge Dr., Gaithersburg, MD 20878. Customer Service 1-800-234-1660.

(Available in all VA libraries) ______________________________________________________________________________________________

Pain as the 5th Vital Sign Toolkit Page 49 City of Hope MAYDAY Pain Resource Center (MPRC) Through a grant from the MAYDAY Fund, researchers at the City of Hope National Medical Center have established the MAYDAY Pain Resource Center (MPRC). The center serves as a clearinghouse for information on improving the quality of pain management. A current index of MPRC material is available on request.

City of Hope National Medical Center The MAYDAY Pain Resource Center 1500 East Durate Road Durate, CA 91010 phone: 818-359-8111 x 3829 fax: 818-301-8941 Web site: http://mayday.coh.org/_private/home.htm Web site resources for pain management Agency for Healthcare Research and Quality (formerly called the Agency for Health Care Policy and Research): http://www.ahrq.gov American Academy of Pain Medicine: http://www.painmed.org American Pain Society: http://www.ampainsoc.org American Council on Headache Education: http://www.achenet.org American Association for the Study of Headache: http://www.aash.org American Headache Society: http://ahsnet.org/ American Geriatrics Society: http://www.americangeriatrics.org American Alliance of Cancer Pain Initiatives: http://www.fhcrc.org/cipr/aacpi American Pain Foundation: http://www.painfoundation.org American Society for the Advancement of Palliative Care: http://www.asap-care.com

American Society of Pain Management Nurses:

http://www.nursingcenter.com/resources/org_info.cfm?id=47E9D2E8-1A98-11D3-8EB0F330E Growth House, Inc. forum on pain management: http://growthhouse.net/~growthhouse International Association for the Study of Pain: http://www.halcyon.com/iasp Joint Commission on Accreditation of Healthcare Organizations: http://www.jcaho.org/ Pain, Palliative and Support care: http://www.jr2.ox.ac.uk/cochrane/ Roxane Pain Institute: http://www.roxane.com Talaria Cancer Pain Management: http://www.talaria.org/ University of Texas, MD Anderson Cancer Center: http://www.mdanderson.org/ University of Wisconsin Pain and Policy Studies Group: http://www.medsch.wisc.edu/painpolicy VA National Formulary Policy: http://vaww.va.gov/publ/direc/health/direct/197047.doc Wisconsin Cancer Pain Initiative: http://www.wisc.edu/wcpi/ Worldwide Congress on Pain: http://www.pain.com ______________________________________________________________________________________________

Pain as the 5th Vital Sign Toolkit Page 50 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Standards Related to the Assessment and Treatment of Pain Background Current Joint Commission standards address pain management only as this applies to care of the dying patient. The following proposed standards have been developed for several chapters of the Accreditation Manual to expand the patient's right to adequate pain assessment and treatment across the continuum of care. These standards and intent statements would require organizations not only to recognize each patient's right to assessment and treatment of pain, but to monitor and manage the pain and to educate staff and patients regarding the importance of effective pain management.

Rights and Ethics Chapter (RI) - Intent for Standard RI.1.2 RI.1.2 Patients are involved in all aspects of their care.

Intent of RI.1.2 Hospitals promote patient and family involvement in all aspects of their care through implementation of policies and procedures that are compatible with the hospital's mission and resources, have diverse input, and guarantee communication across the organization. Patients

are involved in at least the following aspects of their care:

• Giving informed consent;

• Making care decisions;

• Resolving dilemmas about care decisions;

• Formulating advance directives;

• Withholding resuscitative services;

• Forgoing or withdrawing life-sustaining treatment:

• Care at the end of life; and

• Effective pain management.

To this end, structures are developed, approved, and maintained through collaboration among the hospital's leaders and others.

Rights and Ethics Chapter (RI) - Standard RI.1.2.8 and Intent RI.1.2.8 Patients have the right to adequate assessment and treatment of pain.

Intent of RI.1.2.8 Pain is a common part of the patient experience; unrelieved pain has adverse physical and psychological effects. The patient's right to pain management is respected and supported. The organization plans, supports, and coordinates activities and resources to assure the pain of all

individuals is recognized and addressed appropriately. This includes:


Pain as the 5th Vital Sign Toolkit Page 51

• Initial assessment and regular re-assessment of pain;

• Education of relevant providers in pain assessment and management;

• Education of patients and families when appropriate, regarding their roles in managing pain as well as the potential limitations and side effects of pain treatments;

• After considering personal, cultural, and/or ethnic beliefs, communicating to patients and families that pain management is an important part of care.

Assessment of Patients Chapter (PE) -- Standard PE.1.4 and Intent PE.1.4 Pain is assessed in all patients.

Intent of PE.1.4 In the initial assessment, the organization identifies patients with pain. When pain is identified, the patient can be treated within the organization or referred for treatment. The scope of treatment is based on the care setting and services provided. A more comprehensive assessment is performed when warranted by the patient's condition. This assessment and a measure of pain intensity and quality (for example, pain character, frequency, location, duration), appropriate to the patient's age, are recorded in a way that facilitates regular reassessment and follow up according to criteria developed by the organization.

Care of Patients Chapter (TX) - Chapter Overview The goal of the care of patients function is to provide individualized care in settings responsive to specific patient needs.

Patients deserve care that respects their choices, supports their participation in the care provided, and recognizes their right to experience achievement of their personal health goals. The goals of

patient care are met when the following processes are performed well:

• Providing supportive care;

• Treating a disease or condition;

• Treating symptoms that might be associated with a disease, condition, or treatment (e.g., pain, nausea or dyspnea);

• Rehabilitating physical or psychological impairment; and

• Promoting health.

The standards in this chapter address activities involved in these processes, including:

• Planning care;

• Providing care;

• Monitoring and determining outcomes of care;

–  –  –

These activities may be carried out by medical, nursing, pharmacy, dietetic, rehabilitation, and other types of providers. Each provider's role and responsibility are determined by their professional skills, competence, and credentials; the care or rehabilitation being provided;

hospital policies; and relevant licensure, certification, regulation, privileges, scope of practice, or job description.

Care of Patients Chapter (TX) -- Intents for Standard TX.3.3 TX.3.3 Policies and Procedures support safe medication prescription and ordering.

Intent of TX.3.3 Procedures supporting safe medication prescription or ordering address

• Distribution and administration of controlled medications, including adequate documentation and record keeping required by law.

• Proper storage, distribution, and control of investigational medications and those in clinical trial;

• Situations in which all or some of a patient's medication orders must be permanently or temporarily canceled, and mechanisms for reinstating them;

• “as needed” (PRN) and scheduled prescriptions or orders and times of dose administration;

• appropriate use of patient-controlled analgesia (PCA), spinal/epidural, or intravenous administration of medications and other pain management techniques in the care of patients with pain;

• control of sample drugs;

• distribution of medications to patients at discharge;

• procurement, storage, control, and distribution of prepackaged medications obtained from outside sources;

• procurement, storage, control, distribution and administration of radioactive medications;

• procurement, storage, control distribution, administration, and monitoring of all blood derivatives and radiographic contrast media.

Care of Patients Chapter (TX) - Intent for Standard TX.5.4 TX.5.4 The patient is monitored during the post procedure period.


Pain as the 5th Vital Sign Toolkit Page 53 Intent of TX.5.4 The patient is monitored continuously during the post-procedure period. The following items are


• Physiological and mental status;

• Status of or findings related to pathological conditions, such as drainage from incisions;

• Intravenous fluids and drugs administered, including blood and blood components;

• Impairments and functional status;

• Pain intensity and quality (for example, pain character, frequency, location, duration) and responses to treatments; and

• Unusual events or postoperative complications and their management.

Results of monitoring trigger key decisions, such as transfer to an alternative level of care due to a precipitous change in vital signs, or discharge.

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