OR Manager - February 2019 - 16

Patient safety
* educate patients and families
* implement nurse monitoring and use
of tools like the Pasero Opioid-induced
Sedation Scale
* implement specialized monitoring
like capnography for the highest risk
patients.
Revised Medical Staff standard
includes new EP
The Medical Staff standard,
" MS.05.01.03: The organized medical
staff has a leadership role in organization
performance improvement activities
to improve quality of care, treatment,
and services and patient safety, " already
had 17 EPs, and a new EP 18
was added.
EP 18: The medical staff is actively
involved in pain assessment, pain management,
and safe opioid prescribing
through:
* Participating in the establishment of
protocols and quality metrics.
* Reviewing performance improvement
data.
This EP would not be forced on the
entire medical staff, but it could include
three or four physicians on the pharmacy
and therapeutics committee who
look at medication usage over time. It
also could be two or three physicians
who are on the hospital's quality management
committee who study this
data, " says Rosing.
" If you already had established protocols
before January 1, 2018, find out if
they focused on inpatients, outpatients,
discharges, or high-risk patients, " Rosing
says.
He also advises leaders to " look at
what performance measures have been
collected to help you understand adherence
to your protocols and new quality
metrics. "
Many hospitals choose number of
doses sent home with a discharged patient
or guidelines for dosing based on
age. Adverse drug reactions or in-house
use of naloxone also could be a part of
this.
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Changes in Provision of Care
standard
In the revised Provision of Care standard,
" PC.01.02.07: The hospital assesses
and manages the patient's
pain and minimizes the risks associated
with treatment, " the words " and
minimizes the risks associated with
treatment " were added. One EP was
removed, three were revised, and five
were added. The standard now includes
the following eight EPs.
EP 1 (D): The hospital has defined
criteria to screen, assess, and reassess
pain. The " D " means there is
an expectation that this is to be documented,
which means there is a policy
and procedure that guides what these
screening criteria and assessment criteria
are and when to reassess pain, says
Rosing. " This is not new, " he says,
" they just added the words 'screen' and
'reassess.' "
EP 2: The hospital screens patients
for pain during emergency department
visits and upon admission. " This EP
was revised but is not new, " notes Rosing.
EP
3: The hospital treats the patient's
pain or refers the patient for
treatment.
Note: Treatment strategies may include
nonpharmacologic, pharmacologic,
or a combination of approaches.
" This is where the emphasis on alternative
treatments comes in, " Rosing says,
noting that " they don't say which ones
you have to include; it's your choice. "
EP 4 (D): The hospital develops a
pain treatment plan based on evidencebased
practices and the patient's clinical
condition, past medical history, and
pain management goals.
This EP is all new and has a " D " for
documentation.
" If taken literally, this means your
care plan or treatment plan as well as
the physician or licensed independent
practitioner medication orders must be
based on evidence-based practices,
clinical condition, and past history, "
Rosing says. " This drills down to the
patient who is opioid naïve or opioid tolerant
and focuses attention toward creating
a treatment plan that recognizes
preexisting conditions. "
EP 5: The hospital involves patients
in the pain management treatment planning
process through:
* Developing realistic expectations
and measurable goals that are
understood by the patient for the
degree, duration, and reduction of
pain. " We struggle with this one a
little because in the past, patient
involvement meant: What are your
limits of pain? What is your postoperative
pain goal? Do you want
to be pain free? Can you accept a
pain of five? " he says. " Now we
have to be more pronounced in telling
patients that we're probably not
going to be able to accomplish pain
free unless we use high-powered
opioids. We have to almost negotiate
with patients to scale back their
expectations and scale back their
treatment plans to accomplish the
needed degree, duration, and reduction
of pain, " Rosing says. This EP
will again likely require some " Frequently
Asked Questions " to find out
what the surveyors are really looking
for, he says.
* Discussing the objectives used to
evaluate treatment progress, for
example, pain relief and improved
physical and psychosocial function.
* Providing education on pain management
and treatment options and
safe use of opioid and nonopioid
medications when prescribed. " This
EP could entail hard work requiring
a lot of thought and individualization.
It's not just a self-reported pain
scale any longer, " says Rosing. He
suggests trying to tie treatment plan
goals to this EP.
EP 6: The hospital monitors patients
identified as being high risk for adverse
reactions related to opioid treatment.
Continued on page 16
OR Manager | February 2019 15
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