In July 2003 a new MGH Pain Assessment and Management Policy was approved.  Concurrently, the Department of Nursing approved new Guidelines for Pain Assessment and Management.  Both documents are intentionally written broadly enough to apply to any setting, clinical discipline, or patient population.  Where applicable, departments or patient care units can develop additional standards, protocols, or guidelines that support the services provided or that apply to a specific population.

The Policy recognizes that

• patients have a right to pain assessment and management;
• all patients must be assessed for pain;
• pain management is a multidisciplinary collaborative practice;
• effective treatment of pain is contingent upon appropriate assessment and diagnosis;
• pain-related documentation must facilitate reassessment and follow up;
• consistent methods of pain assessment enhance the treatment of pain;
• patients unable to participate in discussion about pain (small children, language minorities, elders with dementia, etc.) are at risk for unrecognized and under treated pain;

• patient education and participation in care planning are essential elements of pain management.

In the new pain Policy, the roles of physicians and nurses in pain management are described, but it is also made clear that “pain management is the responsibility of all clinical disciplines.”  Pharmacy clearly is critical to pain management via its role on the patient care team, or through ad hoc consultation.  Pharmacists also participate through patient safety mechanisms, ongoing quality assurance, patient education, and process improvement initiatives.

The Guidelines

• outline criteria and methods for pain assessment across the lifespan;
• identify minimum outcome goals for pain assessment and management;
• provide guidelines for documentation; and
• provide a general basis for pharmacological and nonpharmacological interventions for pain.
  
  

Extensive appendices provide resources and guidance for pain assessment and management.  Consistent, systematic assessment (and appropriate reassessment) is a prerequisite to pain management.  The Guidelines recommend the 0 – 10 scale and the Wong-Baker FACES scales as the “bread and butter” instruments for assessing pain severity in the vast majority of patients.  There are also developmentally appropriate instruments available for children and for adults who are unable to provide a self-report.  The other major component of collaborative pain management (and that which the JCAHO surveyors will be looking for) is documentation that ties together the assessment, diagnosis, plan/intervention, and patient response to treatment.

Patient Care Services (PCS) is developing a Clinical Resources page for the PCS intranet site.  It will include the complete Policy and Guidelines, including appendices, as well as other pain-related resources.  September is the target for launching this new page.  In the meantime, the Policy and Guidelines may be viewed on the Pain Relief web site (note that the URLs for these pages are for internal MGH use only.  They may be accessed by clicking the links in this article, but are not available as links within the web site).