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PAIN MEDICINE

The Impact of the Joint Commission for Accreditation of Healthcare Organizations Pain Initiative on Perioperative Opiate Consumption and Recovery Room Length of Stay

Departments of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona and Rochester, Minnesota

Address correspondence and reprint requests to Peter E. Frasco, MD, Assistant Professor, Mayo Clinic College of Med, Department of Anesthesiology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale AZ, 85259. Address e-mail to frasco.peter{at}mayo.edu

The enhanced organizational emphasis on the management of pain in hospitalized patients mandated by the Joint Commission for Accreditation of Health Care Organizations (JCAHO) pain initiative precipitated a number of changes by the perioperative services at our facility. In October 2002, a numeric pain scale became mandatory in our postanesthesia care unit (PACU). Response to analgesia in the PACU was recorded using this scale. In addition, an acceptable pain score was required for discharge from the PACU. We evaluated the effects of these changes in the pain management of 1082 patients undergoing general, orthopedic, neurosurgical, urologic, and gynecologic surgeries. We detected an overall increase in the average consumption of opiates (morphine equivalents) in 2002 compared with 2000 (46.6 ± 20.4 mg versus 40.4 ± 13.2 mg, P < 0.001). This increase was most significant in the PACU (10.5 ± 10.4 mg versus 6.5 ± 7.3 mg, P < 0.001 between the 2 periods, respectively). This increase in opiate use was not associated with an increased length of stay, an increase in the requirement for naloxone, or an increase in treatment for postoperative nausea and vomiting. We conclude that the increase in opiate use, which could be explained by compliance with the JCAHO pain initiative, was not associated with additional opiate-induced morbidity in the immediate postoperative period.

IMPLICATIONS: Despite evidence regarding the benefits of effective pain treatment, continued disparities in practice have led the Joint Commission for Accreditation of Health Care Organizations to mandate standards to assure that all patients with pain are identified and appropriately treated. Our study disclosed that, after introduction of new pain standards, postanesthetic care unit use of opiate analgesics increased without significant adverse effects.

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				P. F. White and H. Kehlet Improving Pain Management: Are We Jumping from the Frying Pan into the Fire? Anesth. Analg., July 1, 2007; 105(1): 10 - 12. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999