What are the key concepts organizations need to understand regarding the pain management requirements in the Leadership (LD) and Provision of Care, Treatment, and Services (PC) chapters?

Any examples are for illustrative purposes only.​​​​​​​
^Multimodal analgesia may be described as combining 2 or more analgesic agents or techniques that act by different mechanisms to provide analgesia resulting in improved pain relief while use of fewer opioids.

NOTE: This requirement is not applicable to all settings in the ambulatory care program. Refer to an applicability grid in the E-dition or standards manual for details.

Leadership responsibilities for developing and monitoring performance improvement activities specific to safe opioid prescribing
Whether an individual 'leader' is assigned this responsibility, or a 'leadership team' model is used, responsible leader(s):

• participate in defining the goals and metrics for performance improvement activities;
• allocate resources to conduct performance improvement activities;
• review performance improvement data;
• promote improvement in practices and accountability across disciplines and services involved in pain management and opioid prescribing. 

Facilitating access to the Prescription Drug Monitoring Program (PDMP) means that leadership has implemented systems and processes that support both ease of access for practitioners and consistent access to the PDMP when required by law.  Examples may include:

• Shortcuts on designated computer desktops to the PDMP database
• Links from the organization's intranet site and/or electronic health record (EHR)
• Staff and practitioner education that includes access to and when the PDMP is to be queried
• Demonstration/return demonstration
• Periodic monitoring of compliance as defined 
• Periodic refreshers with staff, as defined by the organization
• Creating prompts in an electronic medical record 

NOTE 1: This element of performance is only applicable in states that have a fully functioning Prescription Drug Monitoring Program (PDMP).
NOTE 2: This requirement is not applicable to all settings in the ambulatory care program. Refer to an applicability grid in the E-dition or standards manual for details.
For example, a pain 'screening' may be used to determine if the patient has pain or not. If the patient answers "yes", a pain assessment would be indicated.  If the patient answers "no" no further pain assessment would be expected, unless required by organizational policy.

Organizations are responsible for ensuring that appropriate screening and (re)assessment criteria and procedures are readily available and used appropriately. The approach to assessing pain may differ depending on a patient's age, condition, and ability to understand. For example, different tools are used for pediatric patients compared to adult patients.  For an episode of acute pain from an identified cause, brief assessment of pain intensity and characteristics may be sufficient.
Chronic pain generally requires more extensive patient assessment, including various domains of physical and functional impairment. Reassessment is conducted as necessary based on the patient's plan of care or changes in his or her condition. 
Pain Assessment and Management Resources