A new threat has emerged in evidence-based management of pain control. Fear.
Evidence-based practice for pain control has 3 elements: BEST available evidence + Clinical judgment + Patient/care partner values and preferences.
In the concern over opioid abuse by some patients & professionals, some federal agencies and nonprofits are suggesting that The Joint Commission (TJC) is inadvertently at fault (http://hosted.ap.org/dynamic/stories/U/US_PAINKILLERS_PAIN_MEASURES?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT). HCAHPS questions are also under suspicion.
While I am not an apologist either for TJC or HCAHPS, my fear is that the government/involved nonprofit fears ignore the data: pain relief is still inadequate for some patients, professionals often under-medicate or don’t believe patients, and some patients have pain crises. Limiting opioids only to certain diagnoses undercuts evidence-based care.
As a professional RN, you need to check out the best available evidence yourself, use your judgment, and 
practice pain assessment & management safely. We know
that asking patients about suicidal intent does not cause them to commit suicide. Does asking patients about pain cause them to have it or to treat pain they don’t have? Hmmm…..
Here are the current TJC standards: 1) The hospital educates all licensed independent practitioners on assessing and managing pain. 2) The hospital respects the patient’s right to pain management. 3) The hospital assesses and manages the patient’s pain.”
Check out this link for truth about the following 5 myths identified by TJC about their standards: http://www.jointcommission.org/joint_commission_statement_on_pain_management/
- Myth#1: The Joint Commission endorses pain as a vital sign….
- Myth #2: The Joint Commission requires pain assessment for all patients….
- Myth #3: The Joint Commission requires that pain be treated until the pain score reaches zero….
- #4: The Joint Commission standards push doctors to prescribe opioids….
Myth #5: The Joint Commission pain standards caused a sharp rise in opioid prescriptions. This claim is completely contradicted by data from the National Institute on Drug Abuse.”… [Source=TJC link above]
Of course, RNs & the health team can always do things better, and the above concerns 
suggest that we might need new studies. I hope only that we won’t jump on the fear bandwagon. Keep practice EVIDENCE BASED, listen to patient/carepartner preferences & values, & use your judgment.
CRITICAL THINKING: How do you assess patient pain? How could you improve? How do you apply TJC standards in your setting?
FOR MORE INFORMATION: Do you know what the TJC pain standards are? Check out the 5 myth link above.
On the experimental unit RNs stated the script to patients exactly as written and on room whiteboards posted the script, last pain med & pain scores. Posters of the script were also posted on the unit. In contrast, on the control unit RN communication and use of whiteboard were dependent on individual preferences. Researchers measured effectiveness of the script by collecting HCAHPS scores 2 times before RNs began using the script (a baseline pretest) and then 5 times during and after RNs began using it (a posttest) on both units.
Critical thinking? What would prevent you from adopting or adapting this script in your own personal practice tomorrow? What are the barriers and facilitators to getting other RNs on your unit to adopt this script, including using whiteboards? Are there any risks to using the script? What are the risks to NOT using the script?
Discovering Your Inner Scientist 