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You worked for a number of years in the office of a family physician who has just retired. You have now taken a position on a busy surgical floor of a local, acute-care hospital. You frequently hear references to JCAHO requirements for documenting a patient's pain assessment and treatment, documenting medication administration, or documenting verbal telephone orders.

Identify 4 requirements for documenting each of the following:

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has now officially recognized that pain is a major health problem. Compliance with JCAHO standards are tied to reimbursement from Medicare, Medicaid and private insurers.

• a patient's pain assessment and treatment

Pain assessment will be provided for all patients as a recorded vital sign along with temperature, pulse, respiration and blood pressure. If there is no pain, that should be recorded.

The amount of pain should be scored with the simplest tool available, such as on a scale from 0 to 10, or no pain/some pain/worst possible pain etc. Non communicative patients might be shown faces indicating degrees of pain.

The amount of pain should be reassessed on a regular basis (decided upon by the facility) and recorded.

Pain assessment should describe intensity, duration, origin, and anything the patient says.

There should be written documentation describing what was done about the pain and an evaluation of the effect of the treatment taken, and any instruction given should be noted.

Patients should be told how much pain to expect by trained health care professionals and not treated as though they are complaining.

King, Stephen, “JCAHO Pain Standards”, Geriatric Times, Nov/Dec 2000, Retrieved February 2011 from,

• medication administration

Orders must be clearly and legibly written. Abbreviations may be used, but certain abbreviations that could be mistaken for actual words must be eliminated from the medical professional’s resources. It is up to the hospital to maintain a list of those abbreviations.

Medications need to be written fresh after surgery or a procedure.

Exact dosages must be noted instead of giving acceptable ranges.

A list of all the medications for a patient must be compiled when transferring the patient to another facility, including the patient’s primary physician upon discharge.

Jcaho Medication Reconciliation, June, 2006, Retrieved February 2011 from

• verbal telephone orders

Verbal and telephone orders are discouraged due to the potential for errors

Facilities need a procedure to assure that medications which are given over the phone are being given to the correct party as decided by the medical facility (usually a registered nurse)

The order must be read back to the original party ordering the medication. It must be read exactly as it is written for disbursement to the patient.

There needs to be a procedure in place for recording the fact that the original order had been read back to the person doing the prescribing.

Lesar, Timmothy, “Telephone and Verbal Orders”, November 2003 Retrieved February 2011 from

What is your opinion on JCAHO's role regarding its documentation requirements to which accredited facilities must comply?

My opinion is that busy nurses and other intake professionals are going to have a lot more paperwork to do. Doctors and other professionals who write the orders for the treatment of patients are going to be taken to task for poor penmanship and lack of clarity. All medical facilities must comply with the Joint Commission in order to receive payments from medical insurance including Medicare and Medicaid, so I don’t see any way out of staying in compliance. Facilities are going to need to become smarter so that they can work faster to stay in compliance.

“Implementing the new pain management standards”, Joint Commission on Accreditation of Healthcare Organizations (2000),. Oakbrook Terrace, Ill.: JCAHO.

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