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    Patient Pain Gets More Attention.


    How do the standards work? The commission is giving hospitals flexibility on the specifics, but according to McIntyre, pain has to be treated as a co-existing condition. "If you have breast cancer, you not only have to be treated for your breast cancer, but for any pain that might be associated with that cancer," she says. "The whole idea is recognizing that pain management is a crucial component of quality care."

    Paul Schyve, MD, the Joint Commission's senior vice president, tells WebMD, "All patients should be asked if they have pain. If they do have pain, then there should be some sort of an instrument used to judge the severity of the pain, which can be used over time to see if the pain changes."

    Some hospitals already have patient-based systems in place; common measuring systems are "happy face/sad face" or "1-10" pain severity charts. At Washington Hospital Center, Rhodes says, "At least every 8 hours, inpatients have their pain rated. ... Every time an outpatient comes through one of our clinics, the pain is rated. Zero is no pain. Ten is the worst pain imaginable. It is what the patient says, not what the physician or nurse feels that the pain rating should be."

    Rhodes tells WebMD that her hospital also gives patients pain education information upon admission, "so they understand that they have a right to pain management and that they also are informed of their pain treatment options."

    Last year, the commission first measured hospitals' pain programs, but didn't score them for accreditation. This year, the grades will count in whether a hospital keeps its accreditation. Schyve won't say how the hospitals did in 2000, but he tells WebMD, "There were certainly a good portion of hospitals that were able to meet the standards quite successfully. It became very clear that these are standards that a hospital can meet."

    But Wolf thinks that hospitals may still have compliance troubles, given that the medical culture has given pain care short shrift.

    "In allowing treatment of chronic ... pain to be included as a 'patients' rights' issue, physicians may be pressured to prescribe opiates in cases in which this is inappropriate," wrote San Gorgonio Memorial Hospital's George Hansen, MD, in a letter to The Journal of the American Medical Association last November. "Patients with chronic pain are at substantial risk for drug abuse and addiction."

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