Hospitals urged to improve monitoring of pain medications.(Clinical Rounds)

LOUISVILLE, KY. -- Overmedication of pain with narcotics and sedatives may be a growing problem in hospitals and should be monitored with the same regularity as pain, Dr. Charles E. Lucas said at the annual meeting of the Central Surgical Association.

The use of scales that assess patients' level of sedation could help to prevent overmedication and potential death, especially when care of patients changes hands during intra- and interhospital transfers, several surgeons said at the meeting.

Many hospitals already have a computerized coding system for undersedation that makes it possible to assess whether a patient has been treated appropriately, but they lack a similar sort of system for overmedication or oversedation, said Dr. Lucas, professor of surgery at Wayne State University, Detroit. He encouraged physicians to develop an oversedation scale.

"In many hospitals, we have a difficult time in reporting these kinds of adverse events [oversedation and respiratory depression] and have an even more difficult time in trying to treat these kinds of adverse events," said Dr. Susan Galandiuk of the University of Louisville. Ky., who led a discussion of the issue. "Many hospitals are reluctant to share this kind of data with physicians."

It may be difficult for some patients to decide whether they need more pain medicine or not, so it is important to recognize the signs of both under- and overmedication, said audience member Dr. Philip E. Donahue. Yet a physician should be aware that it may be a slippery slope for him to stand back and say that enough pain medication has been given, because he may be "looked at as an evildoer," said Dr. Donahue of the John H. Stroger Jr. Hospital of Cook County, Chicago.

In 2001, the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) established pain management standards for accreditation. These standards indicated that patients with a pain score of 5 or greater on the visual analog scale (VAS) must be reassessed to see if they need additional pain medication, Dr. Lucas said. Although the VAS (which is scored from 0 to 10) is only one of many scales that have been developed to rate pain, it is the most often used instrument.

In 2002, the Institute ...