5B Changing Practice from Dosing to Numbers to Survey-Proof Range Orders: An Update

The use of pain intensity rating scales has become integral to inpatient pain assessment in most hospitals in the United States over the past 15 years. An unforeseen consequence of the widespread use of pain intensity scales is the practice of prescribing specific doses of opioid analgesics based solely on specific pain intensity. The American Society for Pain Management Nursing (ASPMN) believes this practice should be prohibited because it disregards the relevance of other essential elements of assessment and may contribute to unwanted patient outcomes, such as excessive sedation and respiratory depression as a result of over medication. The Joint Commission has proposed changes to their pain assessment and management standards with a focus on safe opioid prescribing and measurement of progress toward goals of functional ability, and minimizing risk factors for adverse events caused by pain management treatments. This presentation will provide background for the position paper and identify nursing, prescriber and institutional barriers to change. Presenters will discuss results of a survey that explored implementation of the recommendations in the position paper. Presenters will describe the development of a strategy for intentional implementation of range orders that includes identification of the current institutional state, necessary preliminary work, examples of implementation, and monitoring of safety strategies. Additionally, the presenters will give examples of successful range orders that participants may contemplate and plan for institutional change in prescribers' practices, meets The Joint Commission standards, and improves the safety of all patients receiving opioid therapy in the hospital.