Paper Example on Pain Mgt: ANA, Joint Comm. Codes Provide Optimal Care

Introduction

Patient advocacy ANA Code of ethics ANA Code of ethics provides ethical guidance and support to nurses as they accomplish their obligation of providing optimal care to individuals with pain (American Nurses Association, 2018).

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Pain management Joint Commission The standard requires healthcare organizations provide staff and licensed independent practitioners with educational resources to improve pain management, pain assessment, and safe use of opioid medications according to the identified needs of its patients (The Joint Commission, 2018). It equips physicians and nurses with appropriate knowledge and skills needed for assessment and treatment of pain, prevention of harms from opioid therapy, and management of patients with complex needs.

The standard also needs healthcare organizations facilitate practitioners' access to prescription drug monitoring program (PDMP) databases (The Joint Commission, 2018). PDMPs aggregate prescribing and dispensing data on controlled medications submitted by pharmacies and dispensing practitioners (Joint Commission, 2018). According to the Joint Commission (2018), this standard allows healthcare providers to prevent the misuse of prescription drugs or the illegal diversion of medication. PMDP data enhances evaluation and can help providers to avoid misuse and diversion of medication.

Furthermore, the standard permits the medical director to actively participate in pain assessment and management as well as safe prescription of opioids by developing and communicating medical care procedures, policies, and guidelines (The Joint Commission, 2018). The leader also monitors pain management and prescriptions. In this context, the standard allows medical directors to oversee pain management and ensure responsible opioid prescriptions to prevent inconsistencies in the evaluation of pain treatment, including opioid treatment (The Joint Commission, 2018).

Patient safety Centers for Medicare and Medicaid Services (CMS) Responds to the opioid epidemic by promoting safe and responsible pain management, ensuring patients can access treatment for opioid use disorder, and using data to target prevention and treatment (Center for Medicare and Medicaid Services, 2020).

Promoting patient care and safety Centers for Disease Control and Prevention (CDC) CDC guidelines for opioid prescription improves how opioids are prescribed to ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse and abuse these drugs (Centers for Disease Control and Prevention, 2016).

The standard was established to improve communication between health care providers and patients regarding the benefits and risks of using an opioid prescription for chronic pain (CDC, 2016). It also aimed to provide safer, more effective care for people with chronic pain. Additionally, the standard intended to reduce opioid use disorder and overdose.

To improve pain management and patient safety, the standard helps clinicians determine the appropriate time to begin the prescription of opioids for chronic pain (CDC, 2016). Besides, it gives guidelines on the selection of prescribed opioids. It also patients and clinicians to evaluate the benefits and risks of opioid prescriptions.

Nurse Practice Act (ANA) The nurse practice act protects the public from unscrupulous behaviors of nurses (American Nurses Association, 2018). It has laws and regulations put together to minimize the risk of harm to patients and protect patients by ensuring that the competence level in the nursing department is high (Russell, 2012). The act aims to promote patient safety by ensuring that the patients are receiving quality care.

Part 2

Action Plan Template

Implementation of a non-pharmacological Intervention

Target Date Completion Action steps Accountable person (s) Assigned person (s) Actual completion Date

11/5/2020 Identifying the appropriate therapist

Nurses

physicians Nurses

physicians 13/5/2020

14/5/2020 Discussing the level of pain with the identified therapist

Therapist

Care provider

Patient Therapist

Care provider 14/5/2020

15/5/2020 Determining the length of the therapy. This includes the actual start date and the completion date of the intervention, along with the total sessions required for the treatment.

Physicians

Nurses

Therapist Therapist 15/5/2020

16/5/2020

11/7/2020 Execution: The planned sequence and schedule will be followed to put the program into action.

Evaluation: This will be the final step in implementing CBT. It will occur by establishing milestones, which will be used to assess whether the non-pharmacological intervention succeeded in managing pain.

Therapist

Therapist Therapist

Physician

Therapist 10/7/2020

18/7/2020

Evidence Supporting the Implementation

The Joint Commission (2018) requires healthcare organizations to provide no-pharmacological pain treatment modalities related to the needs of the patients. These modalities act as a modern approach for managing pain. In some circumstances, they can reduce the need for opioid medication. Although specific evidence on the usefulness of non-pharmacologic therapies in long-term care populations is still required, existing evidence suggests that these interventions can be effective in managing older patients with acute and chronic pain (Chang, Fillingim, Hurley, & Schmidt, 2015). Most professional healthcare organizations and physicians believe that non-pharmacologic therapies are necessary components of pain management. According to the Joint Commission (2018), not all pain management needs medication. It is because some medications, particularly opioids, are highly risky drugs that make patients vulnerable to respiratory depression, abuse, and addiction.

Besides, opioid medications have side effects. That is why the commission considers non-pharmacological therapies as the best alternative intervention for treating pain. These options are helpful since they eliminate the need for opioid or reduce the amount of opiates prescribed or used (Knoerl et al., 2016). In doing so, non-opioid treatment options reduce abuse and addiction to the substance, which poses high risk of depression. Joint Commission (2018) further stated that it is imperative to adopt non-pharmacological pain treatment modalities for patients who refuse opioids or believed to benefit from contemporary therapies. Some of the non-pharmacological strategies include physical modalities, music therapy, and Cognitive-behavioral therapy.

For this case, Cognitive behavioral therapy (CBT) is the non-pharmacological method to be implemented. It is a form of talk therapy that will help patients identify and develop skills to change negative thoughts and behaviors (Knoerl et al., 2016). CBT is one of the evidence-based, non-opioid treatment options that the Joint Commission has considered appropriate for treating pain. Meditation techniques used with mindfulness-based stress reduction (MBSR) have been considered to be effective for managing pain. According to The Joint Commission (2018), integrating the biopsychosocial (BPS) model to the management of pain by targeting cognitive reactions to pain and maladaptive behavioral combined with environmental and social factors play a central role in modifying responses to pain. Such therapy has proved efficiency for most psychological and physical disorders, as well as pain.

Continuous pain may result in the development of maladaptive status and behavior that increases distress, worsen daily functioning or enhances experience of pain (Chang, Fillingim, Hurley, & Schmidt, 2015). Patients experiencing pain are often highly vulnerable to various psychiatric disorders such as depression, anxiety and Post-traumatic stress disorder (PTSD). Experts have recommended the use of non-pharmacological therapies as one of the best interventions for pain management. The Joint Commission (2018) included non-pharmacological strategies in its 2018 revised standards. According to the commission, non-pharmacological interventions are significant in managing acute and chronic pain in older patients. They not only decrease pain but also improve functional ability of the patients.

CBT helps to develop significant set of coping skills intended to improve mental functioning, including dogmatic assertive communication, scheduling of pleasurable activities, behavioral activation, structured relaxation exercises and behavior pacing aiming to prevent prolonged pain (Keefe, 1996). CBT for pain also addresses maladaptive thoughts of pain through formal use cognitive restructuring. In other words, CBT will change how patients think or perceive pain. It will also change the physical response in the brain that worsens pain. To implement this strategy, it will be imperative to identify a professional therapist who will help patients manage pain.

Setting Where Implementation will take Place

The implementation will occur at the healthcare setting. This is to comply with Joint Commission standards that require healthcare organizations to provide non-pharmacological pain treatment modalities relevant to the patient needs (The Joint Commission, 2018). Non-pharmacological interventions such as exercise therapy and cognitive behavioral therapy are significant in managing acute and chronic pain in older patients. They not only decrease pain but also improve the functional ability of the patients. Reputable professional healthcare organizations determine them as effective components of pain management. This standard is effective in the treatment of patients with opioid addiction as it helps them cope with the difficult conditions caused by opioid misuse (Doody, Smith, & Webb, 1991). The CBT modality will serve as a modern approach for controlling pain, and on some occasions, it will reduce the need for opioid medications. Implementation of CBT in a healthcare setting will also measure disease management, physical health, and psychological symptoms.

Stakeholders

Stakeholders in CBT intervention will include therapists, nurses, physicians, patients, and families. The therapist will be directly responsible for the implementation of the non-pharmacologic intervention by treating the patient using the CBT program. Physicians and nurses will evaluate the patient during and after CBT to measure the progress. Patients will cooperate with the therapist to receive pain treatment efficiently. To succeed in the implementation, physicians, nurses, and therapists will be required to establish a therapeutic relationship with the patient to build trust and attract the attention of the patients.

Before implementing the intervention, the organization will be required to consider the preferences of the patient for the management of pain. When the organization cannot provide a patient's preference for a safe non-pharmacological treatment, it will be necessary to offer education to patients on where they may access treatment after discharge (The Joint Commission, 2018). It is also necessary to consider the financial ability of the patient. Patients with high income can easily pay for CBT services while those with low income may find it a challenge. Healthcare leaders should, therefore, determine the ability of the patient to pay for CBT services ahead of subjecting them to the program.

Barriers to Implementation

Barriers to implementation of CBT in pain management include factors associated with scheduling, transportation, resources, and costs (Pak et al., 2015). One of the barriers is high treatment costs. CBT involves hiring a therapist to provide treatment for the patient. Insufficient fu...