Identifying and addressing medical errors in pain mismanagement.
BACKGROUND
There is strong evidence in the pain management literature that undertreatment of pain is pervasive despite several approaches, including use of national guidelines, to completely correct the problem. Although the concept of medical errors has primarily been concerned with adverse events, it is not unreasonable that mismanagement of pain could also be classified as a medical error.
Error types can be classified as errors in assessment and documentation, errors in treatment and management, and errors in patient education. Within each of these categories, errors may be skill-, rule-, and/or knowledge-based, as suggested by evidence of mismanagement in various aspects of the pain management process as found in the literature. An examination of the root causes of medical errors may be used to detect system failures. At least ten steps can be identified in the process of pain management in the acute care setting, starting with admission, and errors can potentially occur at any step. A redesigned system could help improve error rates by incorporating use of skills, rules, and knowledge for effective management.


CONCLUSIONS
A new approach to the unsolved problem of pain management in acute care settings is proposed; this approach uses the concept of mismanagement as a medical error.
Starck
P L
PL
University of Texas-Houston Health Science Center School of Nursing, 1100 Holcombe Blvd, Suite 5.500, Houston, TX 77030, USA. pstarck@son1.nur.uth.tmc.edu
Sherwood
G D
GD
Adams-McNeill
J
J
Thomas
E J
EJ
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D004282:Documentation / Q000592:standards; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D019300:Medical Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000592:standards*; D010146:Pain / Q000188:drug therapy*; D010166:Palliative Care / Q000592:standards; D010353:Patient Education as Topic / Q000592:standards; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012985:Software Design; D014481:United States