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Pain Assessment and Management – Understanding the Requirements

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.
Providing staff and licensed independent practitioners with educational programs and resources regarding pain management and safe use of opioid medication.
Research and clinical guidance on pain management are evolving. The intent of the requirement is to provide up-to-date information to practitioners who are involved in patient care. Each organization determines what educational resources and programs to have readily available to staff and licensed independent practitioners, giving consideration to staff needs, services provided, and patient population served. Educational resources available to staff may include academic detailing, workshops, online resources and/or clinical guidelines that include content related to safe opioid prescribing, modalities of treatment, multi-modal pain management*, patient assessment and reassessment criteria.

* 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):
  1. participate in defining the goals and metrics for performance improvement activities;
  2. allocate resources to conduct performance improvement activities;
  3. review performance improvement data;
  4. promote improvement in practices and accountability across disciplines and services involved in pain management and opioid prescribing. 
Survey activities may include staff interviews, review of applicable meeting minutes, discussions with leadership, practitioners, governing body members, review of performance improvement data, etc.

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.

Providing information to staff and licensed independent practitioners on available services for consultation and referral of patients with complex pain management needs.
The intent of this requirement is to ensure that staff and LIPs are knowledgeable about available services and resources. Available sources for consultation and referral may include 'internal' resources (such as a qualified provider with a specific expertise, an organization's outpatient pain management program or addiction treatment program) or external healthcare services and community resources. Compliance with this requirement is determined through interviews with staff, LIPs, patients, etc. 

Practitioner and pharmacist access to the Prescription Drug Monitoring Program (PDMP) databases
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 
Each organization determines who is responsible for accessing the PDMP. This may vary based on different patient care settings. Refer to the state PDMP legislation or regulations to learn about criteria for requesting/checking PDMP data and to determine whether PDMP requirements apply when a controlled substance medication is provided to the patient during a visit at an outpatient setting, an emergency department, etc. During survey, compliance with accessing the PDMP may be evaluated during tracer activities, interviews with staff, practitioners, pharmacists, etc.

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.

Screening vs. assessing pain
A ‘screening’ is a process for evaluating the possible presence of a problem.  An 'assessment' gathers more detailed information through collection of data, observation, and physical examination. Assessments are completed by individuals deemed qualified through education, training, licensure, etc., to conduct such evaluations. Pain assessment tools are generally evidence-based and often include, at a minimum, an evaluation of pain intensity, location, quality, and associated symptoms. An accurate pain screening and assessment is the foundation on which an individualized, effective pain management plan is developed.

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. 

Educating the patient and family on discharge related to pain management
It is the responsibility of each organization to determine who is qualified and responsible to educate the patient and family at discharge regarding the pain management plan, side effects of treatment, impact on activities of daily living, safe use, storage, and disposal of opioids when prescribed. PC.01.02.07 EP 8 requires written documentation that the patient and family were educated on these requirements. Each organization determines where this information will be documented in the medical record.

Pain Assessment and Management Resources
Last updated on January 06, 2021
Manual: Ambulatory
Chapter: Provision of Care Treatment and Services PC

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