14
HOUSE OF REPRESENTATIVES             H.C.R. NO.            H.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                     HOUSE CONCURRENT
                        RESOLUTION
URGING EFFECTIVE PAIN MANAGEMENT PROGRAMS BE REQUIRED IN ALL
   HEALTHCARE INSTITUTIONS.



 1       WHEREAS, death is often accompanied by pain which is severe
 2   enough to make living unbearable; and
 3   
 4       WHEREAS, an interdisciplinary approach to the palliation of
 5   pain can, in most instances, bring relief, comfort, and dignity
 6   during a person's final days; and
 7   
 8       WHEREAS, the Hawaii Cancer Pain Initiative study, "Cancer
 9   Patients' Comfort, Knowledge, and Satisfaction with Pain
10   Management in Acute Care Settings" found that an adequate level
11   of pain control is not always instituted, for instance:
12   
13       (1)  While generally satisfied with their care, sixty-five
14            percent of respondents reported severe pain in the
15            week prior to the study, and forty-five percent
16            reported mild to moderate pain even while being
17            inpatients;
18   
19       (2)  Forty-one percent were unable to identify who of their
20            healthcare team was responsible for their pain
21            management other than their physician;
22   
23       (3)  While healthcare professionals appear to use current
24            guidelines, polypharmacy, or the use of more than one
25            medication from the same class to achieve the same
26            result, exists; and
27   
28       (4)  Multiple routes of administration are common in acute
29            care settings, which tends to reduce the patients'
30            understanding of their pain medications and to
31            increase costs;
32   
33   and
34   
35       WHEREAS, patient-indentified barriers to effective pain
36   relief are:
37   
38       (1)  Failure of caregivers to believe complaints of pain;

 
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                                  H.C.R. NO.            H.D. 1
                                                        
                                                        

 
 1       (2)  Fear of addiction;
 2   
 3       (3)  Undesirable side effects;
 4   
 5       (4)  High costs of opiates; and
 6   
 7       (5)  Delay in response to requests to nurses for
 8            medication;
 9   
10   and
11   
12       WHEREAS, there is a perception that many physicians, who
13   have the greatest responsibility for pain management, have a
14   less than optimal understanding of pain control, such as:
15   
16       (1)  An unreasonable concern regarding the activities of
17            the Drug Enforcement Administration;
18   
19       (2)  Fear of lethal side effects; and
20   
21       (3)  Underestimating the impact of pain on the lives of
22            their patients;
23   
24   and
25   
26       WHEREAS, the Hawaii Medical Association (HMA) has committed
27   itself through a two-year project to train both physicians and
28   nurses to better diagnose and treat pain through its American
29   Medical Association/HMA Education for Physician's on End-of-
30   Life Care program (Program); and
31   
32       WHEREAS, several healthcare institutions in the State have
33   instituted pain management programs that have improved pain
34   management in those institutions, suggesting that requiring
35   pain management programs in healthcare institutions would have
36   a major impact on the lives of patients receiving care in those
37   institutions; and
38   
39       WHEREAS, the Governor's Blue Ribbon Panel on Living and
40   Dying with Dignity unanimously recommended that effective pain
41   management programs be required in all healthcare institutions;
42   now, therefore,

 
 
 
 
 
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                                  H.C.R. NO.            H.D. 1
                                                        
                                                        

 
 1       BE IT RESOLVED by the House of Representatives of the
 2   Twentieth Legislature of the State of Hawaii, Regular Session
 3   of 1999, the Senate concurring, that effective pain management
 4   programs be required in all healthcare institutions; and
 5   
 6       BE IT FURTHER RESOLVED that the Agency for Healthcare
 7   Policy and Research (AHCPR) guidelines for the treatment of
 8   pain be used as a guide for all healthcare providers; and
 9   
10       BE IT FURTHER RESOLVED that the Department of Health
11   establish the right to skilled pain management in a "Patients
12   Bill of Rights" for all certified or licensed facilities; and
13   
14       BE IT FURTHER RESOLVED that pain management programs and
15   guidelines be instituted in each of those facilities; and
16   
17       BE IT FURTHER RESOLVED that all medical, nursing, and other
18   healthcare professional schools in the State be encouraged to
19   incorporate pain management courses into their curricula; and
20   
21       BE IT FURTHER RESOLVED that professional organizations be
22   challenged to formally adopt AHCPR standards and incorporate
23   them in their peer review and continuing education programs;
24   and
25   
26       BE IT FURTHER RESOLVED that HMA and the Hawaii Nurses'
27   Association (HNA) evaluate the pain management component of the
28   Program to determine, among other things, the effectiveness of
29   having all physicians and nurses skilled in pain management for
30   their patients; and
31   
32       BE IT FURTHER RESOLVED that HMA and HNA submit their
33   preliminary findings to the Legislature no later than twenty
34   days prior to the convening of the Regular Session of 2000, and
35   a final report to the Legislature no later than twenty days
36   prior to the convening of the Regular Session of 2001; and
37   
38       BE IT FURTHER RESOLVED that certified copies of this
39   Concurrent Resolution be transmitted to the Agency for
40   Healthcare Policy and Research, the Department of Health, the
41   Healthcare Association of Hawaii, HMA, HNA, the University of
42   Hawaii Schools of Medicine, Nursing, and Public Health, Hawaii
43   Pacific University School of Nursing, statewide community
44   college nursing programs, and all hospitals in the State.