Yes. We had the same recommendation. Here's what our "anes md's" did: We have a pre-printed order form that lists meds with doses based on patients pain levels. We start with the number one analgesic/narcotic, say, Fentanyl up to 200mcg, based on patient's response, then add MS or Dilaudid (if checked off on the pre-printed sheet) if the situation warrants. I see this are a better communication of managing patient pain, based on clearly written guidelines. This saves a lot of unneccessary phone calls for add'l pain med orders. Also, both the RN and MD collobarate to customize the dosing based on indivdual patient factors. Hope this helps. We've used this system now for the past 6 months, and found the we can give narcs, quicker, and pt's pain scores drop quicker, and d/c from the PACU is faster. One caveat. Be careful with OSA patients...they have to stay in our PACU for 3 hours after the last dose of narcotic to monitor for apneic episodes. (we had a sentinel event on the med-surg unit after a OSA patient was d/c'd from PACU after 30 minutes post narcotic. So now, even though we have this pre-printed narcotic pain orders, nursing/medical judgement always rules. JACHO is satisfied, because it is now documented, very clearly, what our approach to pain management is. Isn't that what JACHO is always looking for? A documented approach to trace patient care. Sorry for the long answer, but this was a hot issue in our PACU (large city hospital).