title: The impact of the joint commission for accreditation of healthcare organizations pain initiative on perioperative opiate consumption and recovery room length of stay.
abstract: The enhanced organizational emphasis on the management of pain in hospitalized patients mandated by the Joint Commission for Accreditation of Health Care Organizations (JCAHO) pain initiative precipitated a number of changes by the perioperative services at our facility. In October 2002, a numeric pain scale became mandatory in our postanesthesia care unit (PACU). Response to analgesia in the PACU was recorded using this scale. In addition, an acceptable pain score was required for discharge from the PACU. We evaluated the effects of these changes in the pain management of 1082 patients undergoing general, orthopedic, neurosurgical, urologic, and gynecologic surgeries. We detected an overall increase in the average consumption of opiates (morphine equivalents) in 2002 compared with 2000 (46.6 +/- 20.4 mg versus 40.4 +/- 13.2 mg, P <0.001). This increase was most significant in the PACU (10.5 +/- 10.4 mg versus 6.5 +/- 7.3 mg, P <0.001 between the 2 periods, respectively). This increase in opiate use was not associated with an increased length of stay, an increase in the requirement for naloxone, or an increase in treatment for postoperative nausea and vomiting. We conclude that the increase in opiate use, which could be explained by compliance with the JCAHO pain initiative, was not associated with additional opiate-induced morbidity in the immediate postoperative period.
authors.affiliation: Departments of Anesthesiology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, Arizona and Rochester, Minnesota.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Frasco
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
authors.forename: Terrence L
authors.initials: TL
authors.lastname: Trentman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D004363:Drug Utilization; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007430:Intraoperative Care / Q000592:standards*; D007591:Joint Commission on Accreditation of Healthcare Organizations; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy; D059408:Pain Management; D010147:Pain Measurement; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000453:epidemiology; D011997:Recovery Room; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000188:drug therapy; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D009292:Narcotic Antagonists; D009270:Naloxone; D009020:Morphine