JCAHO Visit an ‘Opportunity’ to Improve Pain Management

WASHINGTON—With a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) visit looming, nurses at George Washington University Hospital used the opportunity to implement a staff education program to improve pain assessment and management.

Reporting at a poster session during the Oncology Nursing Society’s 26th Annual Congress, Pam Malloy, RN, MN, hospital education coordinator, described how her group prepared the nursing staff to meet JCAHO standards for pain management. Little money for extra classes and a short time frame made the task even more challenging.

The first task was to assess the nursing staff’s current level of knowledge by giving a pre-education pain management test (adapted from the postoperative pain study from the University of Wisconsin, Madison). The average score was 55%. Ms. Malloy’s group then developed a 2-day pain management class based on an analysis of the pre-education test results.

A patient education documentation form has been instrumental in facilitating communication among the multidisciplinary team members. Because understanding patients’ perceptions of their pain is the first step toward optimal pain assessment and management, the nursing staff is always looking for new pain assessment tools, Ms. Malloy said.

Current tools include a laminated card that nurses carry in their pocket for quick access when confronted with a patient experiencing pain. The pain scale ranges from 0 (no pain) to 5 (distressing pain) to 10 (unbearable pain). A graphic depiction of pain shows smiling faces, sad faces, and anguished faces; a numerical scale designates 0 as no hurt, 2 as hurts a little bit, and so on.

The education program has translated into action, Ms. Malloy reported. At baseline, 88% of nurses were documenting pain, and the percentage rose to 97% after education. Similarly, at baseline, 70% of RNs were using a numeric or descriptive pain scale, whereas 99% were doing so after education.

Ongoing pain education includes testing and educating new nurses during their orientation. Depending on the new nurse’s unit assignment, he or she may be required to take a pain assessment and management test.

Another important approach is the "bathroom blitz," in which small posters relating a single concept about pain are placed in staff bathrooms. These posters are changed monthly.

The nurse educators continually assess and reassess their educational outcomes. Unannounced chart audits, for example, provide a realistic look at whether a nurse is applying what he or she learned during pain management education. Deficiencies can be addressed—and re-teaching initiated—on the spot.

Finally, patients are educated about their right to appropriate pain assessment and management during their hospitalization. At discharge, patients and their families are given instruction in managing pain at home.