Meeting the JCAHO Challenge for Improving Pain Management: The Cedars-Sinai Approach

Abstract

The federal Agency for Healthcare Policy and Research (AHCPR) published clinical practice guidelines on acute pain management in 1992 and cancer pain management in 1994. In 1998, the American Geriatrics Society published guidelines on the management of chronic pain in the growing elderly population. The fact that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has since developed and implemented standards for pain management further underscores and institutionalizes the importance of appropriate pain management in healthcare. At Cedars-Sinai Medical Center in Los Angeles, California, a Pain Management Steering Committee was convened in 1998 to meet the challenge of improving pain management within the health system. New policies and procedures were developed and implemented which support the appropriate care of patients with pain. A vigorous clinician education campaign was implemented to decrease common misconceptions about opioid use and to promote around-the-clock pain assessment and new pain medication use guidelines discouraging the routine use of meperidine and the intramuscular route of opioid administration. A clinician education toolbox consisting of pocket pain reference guides, self-assessment surveys, “dear doctor” letters. Ongoing data collection on performance improvement in pain management reflected notable changes in physician prescribing habits and awareness of pain management as a “fifth vital sign.” Success in improving pain management practices at our institution is attributable to multiple factors, including the participation of a physician champion, a pain management specialist, a multidisciplinary task force, clinical leadership, and a step-wise approach to implementation of policy changes. Ongoing efforts to meet the JCAHO standards on pain management in the continuum of care are currently in progress.