Making pain a fifth vital sign is a relatively straightforward way to improve pain management. The American Pain Society first promoted the phrase as a way to increase awareness of pain treatment. Simply by requiring routine pain assessment - along with pulse, blood pressure, respirations, and heart rate - organizations make pain management a priority. Teams that try this approach need to simultaneously develop (or use) protocols for managing any pain intensity level greater than 3 (on a 0-to-10 scale).
In 1999, the U.S. Department of Veterans Affairs (VA) launched an ambitious program called "Pain as a Fifth Vital Sign" in all of its medical facilities and in all patient encounters with its health care system. The VA system sees about 3.5 million patients annually, so the effect of this program is likely to be widespread.
The VA notes in its tool kit on pain assessment, "Implementation of `Pain as the Fifth Vital Sign' is a mechanism for identifying unrelieved pain. Screening for pain can be administered quickly for most patients on a routine basis. As with any other vital sign, a positive pain score should trigger further assessment of the pain, prompt intervention, and follow-up evaluation of the pain and the effectiveness of treatment."
Despite the VA's excellent model, providers are likely to encounter colleagues who have trouble adopting this strategy and who may argue:
By anticipating barriers and objections, teams can develop approaches and responses that encourage other health care providers to join in - or, at the very least, to try the idea.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].