HOUSE OF REPRESENTATIVES             H.C.R. NO.14          
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                     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 of "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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 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, several healthcare institutions in the State have
27   instituted pain management programs that have improved pain
28   management in those institutions, suggesting that requiring
29   pain management programs in healthcare institutions would have
30   a major impact on the lives of patients receiving care in those
31   institutions; and
32   
33       WHEREAS, the Governor's Blue Ribbon Panel on Living and
34   Dying with Dignity unanimously recommended that effective pain
35   management programs be required in all healthcare institutions;
36   now, therefore,
37   
38       BE IT RESOLVED by the House of Representatives of the
39   Twentieth Legislature of the State of Hawaii, Regular Session
40   of 1999, the Senate concurring, that effective pain management
41   programs be required in all healthcare institutions; and
42   
43       BE IT FURTHER RESOLVED that the Agency for Healthcare
44   Policy and Research (AHCPR) guidelines for the treatment of
45   pain be accepted as the community standard of care for all
46   healthcare providers; and

 
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 1       BE IT FURTHER RESOLVED that the Department of Health
 2   establish the right to skilled pain management in a "Patients
 3   Bill of Rights" for all certified and/or licensed facilities;
 4   and
 5   
 6       BE IT FURTHER RESOLVED that pain management programs and
 7   the AHCPR guidelines be accepted as practice standards and
 8   instituted in each of those facilities; and
 9   
10       BE IT FURTHER RESOLVED that pain management be part of the
11   required curriculum of all medical, nursing, and other
12   healthcare professional schools in the State of Hawaii; and
13   
14       BE IT FURTHER RESOLVED that professional organizations be
15   challenged to formally adopt AHCPR standards and incorporate
16   them in their peer review and continuing education programs;
17   and
18   
19       BE IT FURTHER RESOLVED that certified copies of this
20   Concurrent Resolution be transmitted to the Agency for
21   Healthcare Policy and Research, the Department of Health, the
22   Healthcare Association of Hawaii, the Hawaii Medical
23   Association, the Hawaii Nurses' Association, the University of
24   Hawaii Schools of Medicine, Nursing, and Public Health, Hawaii
25   Pacific University School of Nursing, statewide community
26   college nursing programs, and all hospitals in the State.
27 
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30                         OFFERED BY:  ____________________________
 
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