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Are JCAHO's pain reassessments doing your patients any good?



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Nov 13, 2009 10:18 PM

Are JCAHO's pain reassessments doing your patients any good?

by janhetherington Premium Member

We had another mandatory meeting about not meeting JCAHO's pain reassessment mandates standards again. If someone's in pain and we do something about it, we have to get back and reassess within a very tight time period. Not ONE MINUTE later. It's really a...pain. I believe in pain management and I believe in following up, but these very specific time limits are driving us nuts. If you give an IM, a couple of pills and an IVP for pain, it's the very devil to try to remember when you have to go back and put some more numbers on patients A through D, and often there are actually more pressing things to do that are physiologically much more important for your patient group. I can't see that it's made any difference in how comfortable our patients are. Some get sick of having to spit out numbers all the time. Is this accomplishing anything other than JCAHO's usual prime directive, to drive the nurses crazy and make patient care more and more difficult? What have you seen?

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11 Comments
No. 1
from nbeck
Old Nov 14, 2009, 12:31 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
Personally, I do believe that the follow up on the effectiveness of pain medication is important and it does actually make a difference if it is done consistently. Yes, it can be a headache to keep up with but it is part of our job. But I've always worked in the PACU or a surgical unit so that was something embedded in my brain as priority. In my facility we do not have to document set numbers every time but we do have a timeframe that we have to reassess effectiveness. If my pt falls asleep within the f/u time frame I'm not going to wake them up I just write a one liner that pt is sleeping with no s/sx of apparent distress, pt resting comforting w/o complaints or something to that effect. But every facility is different, I'm sorry your hospital is so anal (but we all know the hospital is a business and JCAHO is priority for them).
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No. 2
from jessiern
Old Nov 14, 2009, 01:16 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
For patients that really seem to be in pain (yes, I know pain is what the patient says it is), it can be useful, and I would hope a nurse would reassess my pain after medicating.

But, for our usual drug seekers (They really DO exist), it can really complicate things. They can be lauging and cutting up with friends, but their pain will always be a 10/10, requiring follow-up intervention.

I do get busy, and often will loss track of time b/w giving med, and time to reassess. I often tell patients that are A&O that I intend to come back, but in case I get busy, call me in 30 minutes if their pain is not down to a tolerable level. Sometimes they even call in 30 minutes just to let me know "yes, it helped". Not text book, but sometimes you just do the best you can.
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No. 3
from studentmalenurse
Old Nov 14, 2009, 01:19 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
you know something , nobody comes to ever ask the people at the frontline if something is working. I do the same pain reasssessment at my job. It serves very to no little purpose. 1) a pain of 5 for one person is not the same for another person. 2) patients sometimes just guess a number ....ummm maybe its a 6 3) after i give my patient a pain medication and they are sleeping should i wake them up to ask them for a pain number? 4) what do u do with pain numbers of a 10 , when u see the person laughing or half asleep? Do u still document? When is these numbers used? never had a doctor come back and say , umm pain went from a 2 to a 7 , give him morphine stat. We tend to make things that are easy more complicated, a simple question is do u feel the pain medication is helping? And if your pain gets to a point that the medication is not helping , let us know. but as we know if u have an orthopedic patient or sickler they will let u know the pain medication is not working and needs to be changed.
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No. 4
from tjnurse06
Old Nov 14, 2009, 05:01 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
I think it is useless. I have had patients rating pain at a 10 while doing a crossword and talking on the phone. I have also had a patient who fell off a house with a couple obvious deformities rate pain at a 5 while nearly in tears. So is my lady doing the crossword really in more pain than my guy who fell off the roof?
Or the patients that have had Toradol, ativan, morphine and a percocet and is still rating pain at a 10 but not showing any s/s of pain? Do you keep medicating them until they can no longer say the number "10" are overdosed and on a vent?
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No. 5
from MB37
Old Nov 14, 2009, 07:28 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
No. Most of my pain meds are q1h fentanyl (in an ICU), and the docs aren't going to significantly up my dosages based on a pain reassessment 15 minutes in. If after a few hours they're experiencing no relief, or it's getting worse, I might get larger PRN doses ordered. However, I learn this on my hourly assessment, not by coming back in and waking up my poor pt who used their precious little time between assessments to sleep. I document based on a nonverbal pain scale if they're sleeping, but the extra paperwork doesn't help my pts in any way.
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No. 6
from diane227
Old Nov 14, 2009, 07:45 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
Actually, it is bugging the you know what out of them. Pain follow up is one thing. But now we have to round on each patient hourly. They are sick of us.
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No. 7
from nolabarkeep
Old Nov 14, 2009, 08:33 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
I think a simpler scale would suffice. Maybe have a slimmed down rating system such as severe, moderate, minimal, and no pain. We have to reassess on all interventions. Pain is different because it is completely subjective. A pt can't exaggerate changes in HR or BP. It's not going to go away, so try to make it more efficient.
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No. 8
from c0ntagion
Old Nov 14, 2009, 08:39 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
You know what I hate about this policy? I hate the idea of waking up my patient after they finally have good pain control, to ask if he/she is in pain! Personally, if I were that patient, I would be very annoyed. Of course, I don't do this, unless I know the patient will be having a procedure or something in the next hour that will cause pain (to tell them and offer them something beforehand).

I work in an area where I'm often giving IVP pain meds hourly, so this is a huge issue. Our patients don't get enough sleep to begin with due to all the cares, beeps, equipment, tests, etc. It's just one more thing that's going to induce ICU psychosis!
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No. 9
from meandragonbrett
Old Nov 14, 2009, 09:25 AM

Default Re: Are JCAHO's pain reassessments doing your patients any good?
We have to reassess within FIFTEEN, yes, 1-5 minutes of giving a narcotic.

I haven't quite figured out how 2 percocets are going to take effect in 15 minutes....but whatever floats the P&Procedure folks' boat.
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