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PAIN: Clinical Manual

A Resource For Integrating the Revised JCAHO Pain Assessment and Management Standards

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has approved revised standards for pain assessment and treatment for inclusion in the year 2000 Comprehensive Accreditation Manual for Ambulatory Care, Comprehensive Accreditation Manual for Behavioral Health Care, Comprehensive Accreditation Manual for Health Care Networks, Comprehensive Accreditation Manual for Home Care, Comprehensive Accreditation Manual for Hospitals, and Comprehensive Accreditation Manual for Long Term Care. Check the JCAHO website for a copy.

Below is a guide for using McCaffery and Pasero's Pain: Clinical Manual as a resource for integrating the revised JCAHO pain assessment and management standards in your clinical setting.

Chapter 1: Pain Management—Problems and Progress
  • Discusses the concept of “Pain as the Fifth Vital Sign” (p. 3).
  • Provides a “Bill of Rights for People with Pain” (p. 13).
  • Lists the available resources for professional education (p. 6) and clinical practice guidelines (p. 7).
Chapter 2: Basic Mechanisms Underlying the Causes and Effects of Pain
  • Uses a system-by-system approach to present research regarding the harmful effects of unrelieved pain (pp. 23-32).
Chapter 3: Assessment—Underlying Complexities, Misconceptions, and Practical Tools
  • Uses an easily recognized icon to identify pediatric content.
  • Addresses patient, caregiver, and institutional barriers to assessing and managing pain (pp. 36-58), including a section on assessing and documenting pain in challenging patients (pp. 89-99) and a barriers questionnaire designed to assess patients’ attitudes toward pain (p. 93).
  • Offers strategies for improving communication about pain between members of the health care team, including the patient (pp. 84-89).
  • Outlines a process for assessing all types of pain, including questions to ask during the routine admission assessment (pp. 58-62).
  • Provides numerous reproducible tools for documenting and communicating pain, e.g., the Initial Pain Assessment Tool (p. 60), Brief Pain Inventory (p. 61), a variety of pain rating scales in several different languages (pp. 62-78), and inpatient and outpatient pain flow sheets (pp. 78-88).
  • Explains the use of the comfort/function goal (p. 67) and how to teach patients to use the pain rating scale (p. 74).
Chapters 4, 5, 6, and 7: Pharmacology Chapters (Overview, Nonopioids, Opioids, Adjuvants)
  • Uses an easily recognized icon to identify pediatric content.
  • Presents the pharmacologic management of pain.
  • Discusses key analgesic concepts, e.g., around the clock dosing (p. 175) and PCA (pp. 175-177).
  • Provides:
    • Pain management protocols and guidelines (listed inside the book's cover).
    • Examples of reproducible patient educational materials regarding medications and therapies (pp. 126-127, 153-158, 277-292, 345-353), a patient teaching checklist (p. 273), and suggestions for discussing addiction with patients and families (pp. 275-276).
    • Suggestions for collecting and documenting an analgesic history (pp. 124-125).
    • Equianalgesic dose charts: Complete version (nonopioids/opioids, p. 133; opioids, p. 241) and laminated pocket size (free insert and reproducible copy available).
    • Reproducible assessment aids and documentation forms (pp. 124-127).
  • Lists patient assistance programs (p. 194).
Chapter 8: Procedural Pain Management
  • Uses an easily recognized icon to identify pediatric content.
  • Distinguishes between painful and nonpainful procedures (p. 365).
  • Presents the pharmacologic and nonpharmacologic management of procedural pain.
  • Provides procedural pain management protocols and guidelines (page references for appropriate boxes and tables are listed inside the front cover under COMMONLY USED FORMS, CHARTS, AND GUIDELINES, Procedural Pain), including a detailed conscious sedation protocol (pp. 382-384).
Chapter 9: Practical Nondrug Approaches to Pain
  • Addresses misconceptions related to the use of nondrug approaches to managing pain (pp. 400-403)
  • Provides guidelines and protocols for appropriate use of nondrug techniques (pp. 403-405; page references for appropriate boxes are listed inside the front cover under COMMONLY USED PATIENT INFORMATION FORMS AND BOXES, Nondrug Approaches to Pain Management.)
  • Lists resources for clinicians and patients (pp. 423-425).
Chapter 11: Chronic Nonmalignant Pain
  • Addresses barriers and misconceptions related to assessing and managing chronic nonmalignant pain (pp. 469-471).
  • Provides:
    • Protocols and guidelines for pain assessment (pp. 477- 487; 491) and management (pp. 490-499; listed inside the book's cover) of patients with chronic nonmalignant pain, including discussion of suicide, depression, addiction, and long-term use of opioids in this patient population.
    • Reproducible assessment tools and documentation forms (pp. 478-485,.489, 508, 511-512).
    • Patient education tips and materials (pp. 494, 503-507), including helping patients set realistic goals (p. 490).
    • Guidelines for gathering information about pain management programs (p. 515).
  • Lists resources for clinicians, patients, and families (pp. 516-520).
Chapter 13: Pregnancy, Childbirth, Postpartum, and Breast Feeding—Use of Analgesics
  • Addresses misconceptions related to managing pain during pregnancy, childbirth, postpartum, and breast feeding (p. 610).
  • Focuses on pharmacologic management of pain in patients during pregnancy, childbirth, postpartum, and breast feeding.
  • Lists resources for clinicians and patients (pp. 611-612).
Chapter 14: Pain in Infants
  • Addresses barriers and misconceptions related to assessing and managing pain in infants (pp. 627- 631) and harmful effects of unrelieved pain in this population of patients (pp. 631-635).
  • Provides:
    • Tips and reproducible tools for assessing (pp. 631-635, 639-651), documenting (p. 632), and managing (pp. 651-661) pain in infants, including an algorithm for NICU interventions (pp. 662-663).
    • Guidelines and protocols for managing pain in infants (p. 661; 664-667; page references for forms, tables, and boxes are listed inside the front cover under COMMONLY USED FORMS, CHARTS, AND GUIDELINES, Infants).
    • Clinician and family education tips (pp. 661-668).
  • Lists resources for clinicians and families (pp. 668-669).
Chapter 15: Pain in the Elderly
  • Addresses barriers and misconceptions related to assessing and managing pain in the elderly (pp. 675-676).
  • Discusses the idiosyncrasies of pharmacologic and nonpharmacologic pain management in the elderly (pp. 687-700).
  • Provides:
    • A guide to selecting a long-term care facility (pp. 682-683).
    • Tips on assessing and managing pain in complex elderly patients, e.g., cognitively impaired (pp. 686,. 701-705), frail and debilitated (pp. 700-701).
  • Reproducible tools for assessing pain and other conditions, e.g., confusion vs. dementia (p. 704) and alcoholism (p. 705) in the elderly.
  • Lists resources for clinicians, patients, and families (pp. 684-685)
Chapter 16: Building Institutional Commitment to Improving Pain Management
  • Addresses barriers and misconceptions related to improving institutional pain management (pp. 712-713).
  • Details the establishment of the interdisciplinary pain care committee, including composition (p. 716) and troubleshooting (pp. 718-720).
  • Lists pain care committee responsibilities and activities directed toward building institutional commitment to improving pain management (pp. 731-733).
  • Provides:
    • Tools to guide the work of the pain care committee, e.g., resources (p. 717); mission statement and ground rules (pp. 717-718); data analysis tools (pp. 721-723); institutional needs assessment (pp. 724-726); medical record audit (p. 727); knowledge and attitude survey (p. 728); patient questionnaire (p. 729).
    • Example institutional pain assessment and management standards (p. 734) and institutional pain management library (p. 738).
  • Lists preceptorship and pain resource nurse programs (p. 741).
  • Presents contributions and limitations of pain services, role model programs, pain resource nurse programs, and nurse-based PCA services (pp. 739-742).
  • Discusses staff, physician, patient, and family education (pp. 734-738).

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