One size does not fit all: opioid dose range orders.

Abstract

WITH THE INTRODUCTION of The Joint Commission (TJC) pain assessment standards 14 years ago, hospitals nationwide implemented initiatives to improve pain management. 1 Phillips D.M. JCAHO pain management standards are unveiled. JAMA. 2000; 284: 428-429 Crossref PubMed Scopus (454) Google Scholar The ongoing evaluation of pain management practices by TJC and Centers for Medicare and Medicaid (CMS) surveyors during hospital accreditation visits not only continues to fuel attempts to improve the way pain is managed in hospitals, but also has introduced unexpected and concerning consequences. The combination of a focus on reducing undertreated pain, obtaining pain intensity ratings as the primary (and sometimes only) method of pain assessment, and the prevalence of opioid-only pain treatment plans has resulted in an increase in life-threatening opioid-related adverse events. 2 Institute for Safe Medication Practices (ISMP) Pain Scales Don't Weigh Every Risk. Institute for Safe Medication Practices, 2002https://www.ismp.org/newsletters/acutecare/articles/20020724.asp Google Scholar , 3 Lucas C.E. Vlahos A.L. Ledgerwood A.M. Kindness kills: The negative impact of pain as the fifth vital sign. J Am Coll Surg. 2007; 205: 101-107 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar , 4 Pasero C. The perianesthesia nurse's role in the prevention of opioid-induced sentinel events. J Perianesth Nurs. 2013; 28: 31-37 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar , 5 Vila Jr., H. Smith R.A. Augustyniak M.J. et al. The efficacy and safety of pain management before and after implementation of hospital-wide pain management standards: Is patient safety compromised by treatment based solely on numerical pain ratings. Anesth Analg. 2005; 101: 474-480 Crossref PubMed Scopus (202) Google Scholar , 6 White P.F. Kehlet H. Improving pain management: Are we jumping from the frying pan into the fire?. Anesth Analg. 2007; 105: 10-12 Crossref PubMed Scopus (58) Google Scholar Chris Pasero, MS, RN-BC, FAAN, Pain Management Educator and Clinical Consultant in El Dorado Hills, CA