Organizational Standards

The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) monitors and certifies the quality of care provided in the United States so pervasively that JCAHO accreditation constitutes compliance with most requirements for Medicare reimbursement. With the implementation of more aggressive pain management standards by the JCAHO in 2000, prescriptions for opioids increased. The 2000 JCAHO pain standards sought to effect change in four ways: by addressing patients' rights, education and training of patients and families, quantitative aspects of pain, and systematic assessment and safe pain management. In hospitals and other healthcare institutions, professional practice standards are traditionally established and enforced by staff leaders who become mentors and models to colleagues. The JCAHO accreditation standards change physician practice through hospital pressure on physicians and other healthcare providers to comply with JCAHO standards, lest the institution lose its accreditation. Although JCAHO requirements ensure documentation of a patient's pain as a fifth vital sign, shortcomings in JCAHO pain management policies include a lack of provision for health care provider education to remove attitudinal barriers to pain management. Institutional policies on pain management need to protect the legitimate needs of patients in moderate to severe pain to receive adequate opioid pain medication, including education to improve both the attitudes and aptitudes of healthcare providers. Otherwise outside of the hospital setting, these physicians may fall back on familiar ways of under-treating pain in the outpatient arena.