P
hysical pain can have both physiological
and psychological consequences. Therefore, Joint Commission
Care, Treatment, and Services (CTS) Standard CTS.02.01.09, applicable to behavioral health care, requires that organizations screen all individuals served for physical pain. (See “Related Requirements”
on page 3 for the
complete standard.) Many organizations still struggle with compliance. This was one of the 10 most challenging standards for behavioral health care
Partnerships and referral agreements with primary health care providers can help behavioral health care organizations better manage physical pain among individuals served.
organizations during the first half of 2015, with 14% of surveyed organizations found noncompliant.
According to Merlin Wessels, LCSW, associate director, Standards Interpretation Group, The Joint Commission, some behavioral health care organizations have not yet implemented a process to screen individuals for physical pain as they are admitted. “Sometimes the organization does have a process,
but it’s not being implemented consistently or there is no follow-through for individuals who do have pain,” he says.
According to Peter Vance, LPCC, CPHQ, field director, Surveyor Management & Development, The Joint Commission, one of the issues that has made this standard difficult for behavioral health care organizations is that the field has moved toward a more integrated care model, but not all organizations have made the transition successfully. “Behavioral health care covers a wide range of facilities, and not all of them are prepared to address pain,” he says.
Wessels and Vance offer the following five strategies to help behavioral health care organizations better comply with Standard CTS.02.01.09:
Choose a screening method. “There are plenty of pain scales to choose from, so pick one that feels comfortable,” says Wessels. “Also, make sure you’re using a scale that’s appropriate for the person you’re assessing. For example, scales with faces on them may be easier for children or disabled
Related Requirements
Standard CTS.02.01.09
The organization screens all individuals served for physical pain.
Elements of Performance for CTS.02.01.09
The organization screens all individuals served to identify those for whom a physical pain assessment is indicated. (Refer to CTS.02.01.03 through CTS.02.01.07 for more information)
Individuals for whom a physical pain assessment is indicated are either assessed and treated by the
organization or referred for assessment or treatment. Note: Treatment strategies for pain may include pharmacologic and nonpharmacologic approaches. Strategies should reflect an approach centered on the individual and consider the individual’s current
presentation, the health care practitioner’s clinical judgment, and the risks and benefits associated with the strategies, including potential risk of dependency, addiction, and abuse.
For opioid treatment programs: The program employs a multidisciplinary approach for treating patients with both chronic pain disorder and addiction, including both addiction medicine specialists and pain medicine specialists.
Note: The site of such treatment may be either a medical clinic or an opioid treatment program, depending on the patient’s needs and the best utilization of available resources.
For opioid treatment programs: Patients with pain management needs receive their regular opioid medication at adequate doses to treat addiction.
adults than a scale that requires them to choose a pain level on a scale of 1 to 10.” A commonly used pain assessment tool is the Wong-Baker FACES®. (See figure 1, below)
2 Identify an actionable pain threshold. “Determine
management specialists to whom you can refer individuals if your organization is not equipped for assessing and treating pain,” says Vance.
Learn from best practices. “Access The Joint Commission’s Leading Practices Library through your
a pain level at which individuals will be consistently
organization’s
Joint Commission ConnectTM
extranet
referred for pain assessment,” Wessels says. “Everyone who hits that threshold should be referred to a qualified health care provider except for those individuals who are already being treated for pain.” Establish referral sources. “Develop relationships with local primary care practitioners or pain
site,” Vance says. “Do a search for ‘pain screening’ or ‘pain assessment’ to get a better idea of how other organizations are complying with this standard.” Other available resources include the following:
Pain Management: A Systems Approach to
(continued on page 15)
Figure 1. The Wong-Baker FACES Pain Assessment Scale
5 Sure-Fire Methods
(continued from page 3)
Improving Quality and Patient Safety: This document contains learning modules on pain management developed by Joint Commission
Resources in collaboration with Jansen Pharmaceuticals, Inc. It’s available for free download at http://w w w.jcrinc.com/pain-management-a
-systems-approach-to-improving-quality-and-safety/.
.jointcommission.org/topics/pain_management.aspx.
Joint Commission “Speak Up” Campaign podcast on pain management: Listen to expert perspectives at http://w w w. jointcommission.org/topics/speak_up_pain.aspx.
Pain as the 5th Vital Sign Toolkit: A pain management toolkit from the US Department of Veterans Affairs, available at http://www.va.gov
/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit
Evaluate the process and adjust if necessary. “Conduct chart audits and/ or mock tracers to make sure all individuals are being screened for physical pain,” says Wessels. “If there are gaps in the process, additional staff education may be needed.” See the May 2014 issue of The Source (available at http://www.ingentaconnect.com/search/article?option1=tka&value1=mock
+tracer&operator3=AND&option3=journalbooktitle&value3=joint+source
&sortDescending=true&sortField=default&pageSize=10&index=3) for a primer on how to conduct your own mock tracers. TS