Evidence-based practice is threatened by litigation: the case of the American Pain Society

Amelia Swift is a lecturer in nursing on the University of Birmingham and a member of the Council of the British Pain Society.

The National Health Service Structure sets out the patient’s right to secure, effective and evidence-based health care (1). Skilled codes of conduct, comparable to the Code (2) for Nurses and Midwives, clearly state that our practice have to be based on the “best available evidence”. Furthermore, the Nursing and Midwifery Council Standards (3) for the education of nurses and midwives also make serial references to the necessity for education that promotes the effective use of research evidence and the necessity for nurses to accumulate the talents crucial for evidence-based practice. In brief, evidence-based practice (EBP) is a fundamental and irrefutable principle that’s widely accepted by many stakeholders.

Failure to comply with EBP may end in harm to the patient requiring redress. Serious errors in care in organizations comparable to Mid-Staffordshire NHS Trust (4) result in inquiries which inevitably discover failure to stick to evidence-based standards of care as a key element. As nurses, we have now an obligation to look after our patients, and failure to exhibit appropriate competence in our actions may end in disciplinary proceedings and prosecution. The fee of clinical negligence in trusts was around £60 billion in 2016/17 (5) and is rising 12 months on 12 months.

Recently, the American Pain Society (APS), the national chapter of the International Association for the Study of Pain, filed for bankruptcy. The cause was an unsustainable attack on the corporate’s charitable funds by lawyers searching for redress for clients affected by the “opioid epidemic.” The organization stated that efforts to resolve “meritless” lawsuits without initiating lengthy and dear legal proceedings have been unsuccessful (6). APS has been on the forefront of advocating for increased investment in pain research and publishes a highly respected journal (The Journal of Pain) that has published research on the “opioid crisis” and the secure and effective use of opioids. In other words, a respected group of clinicians, researchers, and educators who advocate for patients and promote secure, evidence-based practices have been decimated by repeated attacks which might be deemed baseless (in other words, there is no such thing as a evidence to support them). .

It is extremely likely that the fundamental focus of the legal attempts was the APS campaign to enhance the assessment and treatment of pain by recognizing pain because the fifth vital sign (7). One in every of the unintended results of the campaign was a rise in over-aggressive opioid prescribing, and this concept has now been abandoned, but only after it was widely adopted within the UK (8) and celebrated and endorsed by healthcare and other organizations and businesses. On the time, it gave the impression of a superbly reasonable method to improve consistently poor pain management practices. The dimensions of the “opioid crisis” suggests that APS is not going to be the one victim. This just isn’t a uniquely American problem, despite the (mythical) belief that it’s a very litigious society (9). A fast Google search reveals loads of UK law firms willing to tackle cases involving pressure ulcers brought on by a nurse’s failure to answer a risk assessment, and no less than one firm specializing in failure to manage medications comparable to painkillers .

This leads me to wonder what number of other organizations that publish guidance and seek to influence practice and policy will turn into less risk averse, ultimately resulting in increasing difficulties for practitioners to find the evidence they need.

Bibliography:

1. Department of Health and Social Care. NHS Structure for England London, UK: DHSC; 2015[Availablefrom:https://wwwgovuk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-englandaccess:26062019[Availablefrom:https://wwwgovuk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-englandaccessed26/06/192019[Dostępnepodadresem:https://wwwgovuk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-englanddostęp:26062019[Availablefrom:https://wwwgovuk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-englandaccessed26/06/192019
2. Council of Nurses and Midwives. Code: skilled standards of practice and behavior for nurses and midwives. London: Nursing and Midwifery Council, 2018.
3. Nursing and Midwifery Council. Standards Framework for Nursing and Midwifery Education 2018[Availablefrom:https://wwwnmcorguk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/[Availablefrom:https://wwwnmcorguk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/[Dostępnenastronie:https://wwwnmcorguk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/[Availablefrom:https://wwwnmcorguk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/
4. Francis R. Mid-Staffordshire NHS Foundation Trust Public Inquiry Report. London, 2013.
5. National Audit Office. Managing the prices of clinical negligence in trusts. London: Department of Health, 2017.
6. Pain News Network. American Pain Society Files for Bankruptcy: Pain News Network; 2019[Availablefrom:https://wwwpainnewsnetworkorg/stories/2019/6/29/american-pain-society-files-for-bankruptcyaccess:20072019[Availablefrom:https://wwwpainnewsnetworkorg/stories/2019/6/29/american-pain-society-files-for-bankruptcyaccessed20/7/192019[Dostępnepodadresem:https://wwwpainnewsnetworkorg/stories/2019/6/29/american-pain-society-files-for-bankruptcydostęp:20072019r[Availablefrom:https://wwwpainnewsnetworkorg/stories/2019/6/29/american-pain-society-files-for-bankruptcyaccessed20/7/192019
7. American Pain Society Commission on Quality of Care. Guidelines for improving the standard of treatment for acute and cancer pain. Journal of the American Medical Association 1995;274:1874-80.
8. Levy N, Sturgess J, Mills P. Within the USA, pain because the fifth sign of life and addiction to the numerical pain scale are being abandoned: Why? BrJAnaesth, 2018:435-38.
9. Walshe S. America’s “Contitutive Society” is a myth. Guardian 2013 October 24, 2013.

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