Managing pain: the fifth vital sign.

Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s, and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations from national guidelines and authoritative resources, retooling and updating of the pain management program was shaped to include a multidisciplinary team approach, principles of Total Quality Improvement, and outcomes management. Guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model and the leadership of clinical nurse specialists, organization-wide pain management initiatives have contributed to improved pain management practices. The end-point goal of a comprehensive pain management program that demonstrates positive patient outcomes along the care continuum provides an opportunity for merged health care organizations at two sites. This challenge will be supported by the model and the principles of continuous quality improvement, two processes that are complementary in assuring best practice.