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Steps in the Process of Acute Care Pain Management from Admission

V O L U M E 2 7 N U M B E R 4 1 9 1 For at least three decades, health professionals have documented that undertreatment of pain is pervasive, occurring with one-half to onethird of hospitalized patients. Various measures have been tried to correct this problem, including development of national guidelines by governmental agencies, professional group associations, and international organizations. Yet the problem persists. Recently, the Joint Commission on Accreditation of Healthcare Organizations (Oakbrook Terrace, Ill) has specified comprehensive pain management standards. One requirement is that the organization include a statement regarding its commitment to pain control in its mission statement, policy manual, and/or bill of rights. The Joint Commission specifies patient rights and responsibilities and gives specific directives for caregivers; it also requires incorporation of pain assessment as the fifth vital sign and use of a consistent rating scale. Why has this area of clinical excellence been so difficult to achieve? Will standards and requirements at long last ameliorate this problem? In this article, we propose an adjunctive model to be used as organizations try to bring about change in the clinical culture and in the behavior of caregivers and patients/families. In recent years, the health professions have taken significant steps in declaring their intent to openly examine and confront medical errors occurring in the process of delivering care. The health care professions have examined theories about why errors occur and the experiences of other industries. The conclusion has been that many errors in health care are likely the result of system failures rather than of isolated actions of practitioners. Investigators have used this approach to document the system errors that This discussion of how to identify system-level errors in pain management should be useful to both health care systems and practicing clinicians.