Joint Commission proposes new pain management standards

Critical access hospitals, ambulatory care and office-based surgical practices would be subject to new requirements for pain assessment and management under proposals released by the Joint Commission, with safe prescribing of opioids needing to be an “organizational priority” in all three settings.

The proposed standards have some differences in the different settings. In general, however, the new requirements put a greater emphasis on addressing the risk of patients developing addictions and dependencies in facilities’ pain management strategies.

For example, all three settings’ proposed standards would make minimizing “the risk associated with treatment,” along with the organization assessing and managing the patient’s pain, part of the commission’s elements of performance. Whereas the existing standards said strategies should reflect the potential risk of addiction and abuse, the new standard would replace it with something more detailed.

“The organization develops an individualized pain treatment plan that includes nonpharmacologic, pharmacologic or a combination of approaches based on evidence-based practices and the patient’s clinical condition and past medical history,” the proposed standards read.

Facilities would also need to involve patients in developing their pain management plans by educating patients on their options, how to use opioid and non-opioid medications safely, as well as “developing realistic expectations” for the degree, duration and reduction of pain.

Upon discharge, all three settings would need to educate patients and their families on how their pain management treatments could result in side effects as well as how opioids should be stored and disposed of when prescribed. Making sure excess prescription opioids aren’t so easily obtainable for people other than the patient to which they’ve been prescribed has been repeatedly mentioned as a priority for federal lawmakers and agencies seeking to address the opioid epidemic.

The Joint Commission proposals also appeared to align with more recent research on opioids. A March 2018 study found opioid use didn’t result in better outcomes than non-opioid alternatives for patients with back, hip and knee pain. One argument from prescribers—that they ended to provide more painkillers to help their patient satisfaction scores—was questioned in a May 2017 study which found no such impact.

The new standards were first released on April 11. Comments will be accepted until May 22.