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

                     HOUSE  RESOLUTION

 1       WHEREAS, death is often accompanied by pain which is severe
 2   enough to make living unbearable; and
 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
 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:
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;
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;
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
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;
33   and
35       WHEREAS, patient-indentified barriers to effective pain
36   relief are:
38       (1)  Failure of caregivers to believe complaints of pain;
40       (2)  Fear of addiction;

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                                  H.R. NO.              H.D. 1

 1       (3)  Undesirable side effects;
 3       (4)  High costs of opiates; and
 5       (5)  Delay in response to requests to nurses for
 6            medication;
 8   and
10       WHEREAS, there is a perception that many physicians, who
11   have the greatest responsibility for pain management, have a
12   less than optimal understanding of pain control, such as:
14       (1)  An unreasonable concern regarding the activities of
15            the Drug Enforcement Administration;
17       (2)  Fear of lethal side effects; and
19       (3)  Underestimating the impact of pain on the lives of
20            their patients;
22   and
24       WHEREAS, the Hawaii Medical Association (HMA) has committed
25   itself through a two-year project to train both physicians and
26   nurses to better diagnose and treat pain through its American
27   Medical Association/HMA Education for Physician's on End-of-
28   Life Care program (Program); and
30       WHEREAS, several healthcare institutions in the State have
31   instituted pain management programs that have improved pain
32   management in those institutions, suggesting that requiring
33   pain management programs in healthcare institutions would have
34   a major impact on the lives of patients receiving care in those
35   institutions; and
37       WHEREAS, the Governor's Blue Ribbon Panel on Living and
38   Dying with Dignity unanimously recommended that effective pain
39   management programs be required in all healthcare institutions;
40   now, therefore,
42       BE IT RESOLVED by the House of Representatives of the
43   Twentieth Legislature of the State of Hawaii, Regular Session
44   of 1999, that effective pain management programs be required in
45   all healthcare institutions; and
47       BE IT FURTHER RESOLVED that the Agency for Healthcare
48   Policy and Research (AHCPR) guidelines for the treatment of
49   pain be used as a guide for all healthcare providers; and

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                                  H.R. NO.              H.D. 1

 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 or licensed facilities; and
 5       BE IT FURTHER RESOLVED that pain management programs and
 6   guidelines be instituted in each of those facilities; and
 8       BE IT FURTHER RESOLVED that all medical, nursing, and other
 9   healthcare professional schools in the State be encouraged to
10   incorporate pain management courses into their curricula; and
12       BE IT FURTHER RESOLVED that professional organizations be
13   challenged to formally adopt AHCPR standards and incorporate
14   them in their peer review and continuing education programs;
15   and
17       BE IT FURTHER RESOLVED that HMA and the Hawaii Nurses'
18   Association (HNA) evaluate the pain management component of the
19   Program to determine, among other things, the effectiveness of
20   having all physicians and nurses skilled in pain management for
21   their patients; and
23       BE IT FURTHER RESOLVED that HMA and HNA submit their
24   preliminary findings to the Legislature no later than twenty
25   days prior to the convening of the Regular Session of 2000, and
26   a final report to the Legislature no later than twenty days
27   prior to the convening of the Regular Session of 2001; and
29       BE IT FURTHER RESOLVED that certified copies of this
30   Resolution be transmitted to the Agency for Healthcare Policy
31   and Research, the Department of Health, the Healthcare
32   Association of Hawaii, HMA, HNA, the University of Hawaii
33   Schools of Medicine, Nursing, and Public Health, Hawaii Pacific
34   University School of Nursing, statewide community college
35   nursing programs, and all hospitals in the State.