title: From documentation to the problem: controlling postoperative pain.
abstract: OBJECTIVE
  Adequate pain control continues to be an enigma in the face of the Joint Commission (TJC) well-intended pain management standards. Notable in the pain standards is the mandate to make pain the fifth vital sign to increase pain visibility and awareness.
  
  
  METHODS
  The following databases were searched: EBSCOHost, CINHAL, PubMed Central, Medline, and government/societies sites for guidelines on pain control. Various search terms used included pain, post operative pain, pain control, pain as the 5th vital sign, pain documentation, pain assessment, Joint Commission Pain Standard, PRN effectiveness, and pay-for-performance.
  
  
  RESULTS
  Accredited facilities are mandated to have plans to assess for pain and evaluate pain management effectiveness. These mandates have necessitated a flurry of initiatives and programs by hospitals and healthcare facilities focusing on documentation processes to meet TJC compliance. Notable programs include Pain as the 5th Vital Sign and PRN (as needed) effectiveness documentation. Many facilities have programs to assess and document pain but lack programs that effectively control patient's pain.
  
  
  CONCLUSIONS
  This article is a call for facilities to refocus on pain control. A need to evaluate current programs by facilities is evident. Studies show that Pain as the 5(th) Vital Sign and PRN effectiveness documentation are not effective and invariably have not met the goals of TJC pain standard--adequate and effective pain control.
authors.affiliation: Surgery Department, Michael E. DeBakey VA, Houston, TX, USA. iunworah@sbcglobal.net
authors.forename: Uchenna
authors.initials: U
authors.lastname: Nworah
mesh_terms: D004282:Documentation / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D037141:Mandatory Programs; D009733:Nursing Diagnosis / Q000379:methods / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010146:Pain / Q000503:physiopathology; D059408:Pain Management / Q000592:standards*; D010149:Postoperative Pain / Q000451:nursing* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012052:Reimbursement, Incentive; D014481:United States