The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 4: PainJCAHO Pain StandardsEffective January 1, 2001, the Joint Commission on Accreditation of Healthcare Organizations(JCAHO)26establishedpicasnew pain management standards for accreditation. 63 These standards includethe following statements:• Individuals served have the right to appropriate assessment and referral for a provision ofmanagement of pain• Pain must be assessed in all individualsSome key concepts of the JCAHO standards are listed in Table 4-5. The complete standards areavailable at www.jcaho.org/standard/pm_hap.html. The pain assessment tools and measures describedabove can help organizations and practitioners comply with these standards. The generalprinciples of pain assessment and management described in this chapter may also be helpful.Other sources of help in meeting the pain standards include Building an Institutional Commitmentto Pain Management: The Mayday Resource Manual for Improvement, an excellent compilationof resource material to promote institutional support of pain management; all of the sampleresource tools are available on a disc. Available from Wisconsin Cancer Pain Initiative, 3675 MedicalSciences Center, Univ. of Wisconsin Medical School, 1300 University Avenue, Madison, WI 53706; 608-262-0278, FAX 608-265-4014; E-mail aacpi@aacpi.org or www.aacpi.org. 64IVTable 4-5: JCAHO Pain Standards• Recognize the right of patients to appropriate assessment and management of pain.• Assess the existence and, if so, the nature and intensity of pain in all patients.• Record the results of the assessment in a way that facilitates regular reassessmentand follow-up.• Determine and assure staff competency in pain assessment and management, andaddress pain assessment and management in the orientation of all new staff.• Establish policies and procedures which support the appropriate prescription orordering of effective pain medications.• Educate patients and their families about effective pain management; and addresspatient needs for symptom management in the discharge planning process.Sources: JCAHO Pain Standards. www.jcaho.org/standard/pm_hap.html. Also, HRSA. www.hrsa.gov.Multimodal ApproachFederal guidelines developed by the Agency for Health Care Policy and Research (AHCPR) for themanagement of cancer pain also address the issue of pain management in AIDS. The guidelinesstate, the principles of pain assessment and treatment in the patient with HIV/AIDS are not fundamentallydifferent from those in the patient with cancer and should be followed for patients withHIV/AIDS. 58 In contrast to pain in cancer, pain in HIV disease more commonly may have an underlyingtreatable cause. 10U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 103