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TMC Hosts Discussion on JCAHO's New Pain and Palliative Care Standards
By KATHLEEN CHARTER
Texas Medical Center News
PAIN AND PALLIATIVE CARE PARTICIPANTS--Nearly 100 Houston health care practitioners and other interested participants recently discussed the Joint Commission's new standards required pain management and palliative care.
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The Texas Medical Center recently hosted the largest gathering of people interested in pain and palliative medicine in its history. Nearly 100 health care professionals and other interested Houston participants discussed the Joint Commission on Accreditation of Healthcare Organizations' standards for required pain management and palliative care in accredited hospitals.
According to the American Pain Foundation, 50 million Americans experience chronic pain. In addition, the foundation reports that 40 percent of cancer patients and 50 percent of post-surgery patients receive inadequate pain relief.
As of January 1 of this year, the nation's hospitals were required to make a major change to address this problem. New standards set forth by the Joint Commission now require hospitals to measure patients' pain regularly, from check-in until discharge, and provide proper pain relief when indicated. Until this year, no such standards have existed. Pain is the newest "vital sign" to be measured routinely during a hospital stay, like its four predecessors - blood pressure, pulse, body temperature and respiration.
Dr. Richard Wainerdi, president of the Texas Medical Center; Dr. Roger Anderson, pharmacy director at The University of Texas M. D. Anderson Cancer Center; Dr. Porter Storey, associate professor of geriatric medicine at Baylor College of Medicine and medical director of palliative care services at St. Luke's Episcopal Hospital; Dr. Stratton Hill, Emeritus Professor of Medicine at The University of Texas M. D. Anderson Cancer Center; and Dr. Mustafa Lokhandwala, University of Houston College of Pharmacy dean, led the discussion about how institutions are coping with the Joint Commission's accreditation issue, and how they can help each other with education, both continuing and formal, and the pharmacological issues that the new standards raised.
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Copies of the Joint Commission's new standards are available for viewing at the Houston Academy of Medicine-Texas Medical Center Library. The Texas Medical Center institutions have been working to implement these new standards in the following ways:
- Addressing each individual component of the JCAHO standards
- Educating physicians, nurses, chaplains and other personnel who deal with patients, on understanding pain management and assessment
- Pain management interventions
- Patient surveys to assess quality of care
- Pain management brochures that include such subjects as teaching parents how to non-pharmacologically manage their children's pain
- Alliance with the University Center for Pain Management and Rehabilitation
- Coordination of nurses with attending staff
- Closed-circuit television systems for adult patient education
- Development of standardized adult and pediatric scales to assess pain
- Summaries of patients' rights and responsibilities
- Computerized patient record systems to document the process of patient assessment, education, reassessment, and individualized care plans
- Integrating and educating satellite clinics about how to ensure consistent care
- Implementing chronic pain clinics
- Utilization of university-developed video tapes for patient education that are available for viewing via hospital television systems
- Online health care professional and patient education newsletters
- Pain research teams to evaluate institutional pain management practices
- Bilingual assessment tools
- Taking into account patients' cultural and religious beliefs
Dr. Lokhandwala said, "At the present time, we spend a significant amount of time teaching curriculum about pain, mechanisms of, or drugs that alleviate, pain. All of this is being looked at with the intent to modify and enhance what we do in order to meet these new requirements."
"This issue is certainly of great interest to a lot of people," said Dr. Anderson. "It is apparent that all the disciplines must work together, and in fact, from what I see, they are."
"Pain management is certainly a part of patient rights," he continued, "and so much of the information includes the patient and family members. Assessment is a huge part of this, as well as continuing care. These new standards are really a positive thing."
Dr. Storey added that fears of harming patients and interactions with patients who are getting sicker and are unable to communicate their pain could be dissolved with the implementation of continuing education. He said resource people need to be trained on each and every hospital floor, so that patients have a place to turn when they don't know where else to find help.
"The new requirements for accreditation in pain is a step toward patient empowerment," said Dr. Hill. "I wrote an editorial for JAMA in 1995, titled `When Will Adequate Pain Treatment be the Norm?' The norm now is inadequate. My conclusion was that it won't be the norm until patients demand it. They must be empowered to demand this pain relief."
"A number of the institutions have elaborate continuing education programs. I think that this continuing education is very valuable, not only for practitioners, but also for the community," said Dr. Wainerdi.
In addition to support groups, another important local resource is the Chronic Pain Report, a monthly newsletter for patients in pain. It is a grass-roots effort, which contains articles on such topics as "How to Talk to Your Doctor" and "Where to Find Support Groups." Helen Dearman, editor of the newsletter, is a support group representative of the American Chronic Pain Association. She also has a unique vantage point as a chronic pain patient.
"My goal is to provide newsletters for medical offices where pain patients will eventually go, such as primary care physicians, pain doctors, orthopedic surgeons, pain psychologists, an so forth. Instead of having People, Good Housekeeping, or Sports Illustrated to read, we want them to have something to let them know that they are not alone," Dearman said.
If you are interested in joining the Pain and Palliative Care Group, please contact Marilyn Jones at (713) 791-8800 or mjones@texmedctr.tmc.edu.
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Support groups are available for chronic pain patients and health care professionals interested in pain management.
The Pain and Palliative Care Group meets every two months. Membership is free and open to patients, physicians, and anyone interested in the subject. Topics covered include record keeping, institutional approaches to pain management and palliative care, patients' point of view, and problems that chronic pain patients may face with employers. The next program is scheduled for the end of April.
The Methodist Hospital, together with M. D. Anderson and the Hermann Pain Center, hosts a pain fellowship training group, open to the public, which meets on the 19th floor of Scurlock Tower Friday mornings from 7:30 to 8:30.
M. D. Anderson has an ongoing pain lecture series Mondays at noon in the Frank E. Anderson Lecture Hall.
The University of Texas/Hermann Pain Center holds a weekly conference where chronic pain patients' care plans, interventions and techniques are discussed.
The Texas Pain Society is initiating an epidemiological study of pain in Texas.
The Texas Cancer Pain Initiative can provide health care professionals with pocket-sized laminated dose conversion cards.
The Texas Partnership for End-of-Life Care has quarterly meetings, usually held in Austin's Texas Medical Association building, that are free and open to the public. The next meeting is Wednesday, May 9, from 9 a.m. to 4 p.m.
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©2006 Texas Medical Center
E-Mail: tmcinfo@texmedctr.tmc.edu
URL: http://www.tmc.edu/tmcnews/03_15_01/page_02.html
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