Table 3.

Strength of recommendation for actionable standards

Actionable standards	GRADE strength of recommendation
LD.04.03.13, EP 2: The critical access hospital provides non-drug pain treatment modalities	B
PC.01.02.07, EP 4: The organization develops a pain treatment plan based on evidence based practices and the patient’s clinical condition, medical history, and pain management goals	C
PC.01.02.07, EP 3: The organization treats the patient’s pain or refers the patient for treatment	C
NPSG.01.01.01, EP 3: For newborn patients: use distinct methods of identification for newborn patients	C
LD.04.03.13, EP 7: Critical access hospital leadership works with its clinical staff to identify and acquire the equipment needed to monitor patients who are at high risk for adverse outcomes from opioid treatment	C
LD.04.03.13, EP 3: The organization provides staff and licensed independent practitioners with educational resources to improve pain assessment, pain management, and the safe use of opioid drugs based on the identified needs of its patient population	C
LD.04.03.13 EP 1: The organization has a leader or leadership team that is responsible for pain management and opioid prescribing and developing and monitoring performance improvement activities	C
PI.02.01.01, EP 19: The organization monitors the use of opioids to determine if they are being prescribed safely	D
PI.01.01.01, EP 40: The critical access hospital collects data on pain assessment and pain management, including types of interventions and effectiveness	D
PC.01.02.07, EP 8: The organization educates the patient and family on discharge plans related to pain management, including the following: pain management plan of care; side effects of pain management treatment; if applicable, activities of daily living, including the home environment, that might exacerbate pain or reduce effectiveness of the pain management plan of care, as well as strategies to address these issues; safe use, storage, and disposal of opioids when prescribed	D
PC.01.02.07, EP 7: Based on the patient’s condition, the organization reassesses and responds to the patient’s pain through the following: evaluation and documentation of responses to pain interventions; progress toward pain management goals, including functional ability	D
PC.01.02.07, EP 5: The organization involves patients in the pain management treatment planning process through the following: developing realistic expectations and measurable goals that are understood by the patient for the degree, duration, and reduction of pain; discussing the objectives used to evaluate treatment progress; providing education on pain management, treatment options, and safe use of opioid and non-opioid drugs when prescribed	D
PC.01.02.07, EP 2: The critical access hospital screens patients for pain during emergency department visits and at the time of admission	D
PC.01.02.07, EP 1: The organization has defined criteria to screen, assess, and reassess pain that are consistent with the patient’s age, condition, and ability to understand	D
PC.01.02.01, New EP 16: For critical access hospitals that provide obstetric services: if the mother tests positive for HIV, hepatitis B, group B streptococcus, or syphilis when tested in labor and during delivery, that information is also documented in the newborn’s medical record after delivery	D
MS.05.01.01, EP 18: The medical staff is actively involved in pain assessment, pain management, and safe opioid prescribing through the following: participating in the establishment of protocols and quality metrics; reviewing performance improvement data	D
LD.04.03.13, EP 6: The organization facilitates practitioner and pharmacist access to the Prescription Drug Monitoring Program databases	D
LD.04.03.13, EP 5: The critical access hospital identifies opioid treatment programs that can be used for patient referrals	D
LD.04.03.13, EP 4: The organization provides information to staff and licensed independent practitioners on available services for consultation and referral of patients with complex pain management needs	D
PI.02.01.01, EP 18: The critical access hospital analyzes data collected on pain assessment and pain management to identify areas that need change to increase safety and quality for patients	D

GRADE=Grading of Recommendations, Assessment, Development, and Evaluation; EP=element of performance.

A indicates a strong recommendation with high quality evidence, such that further research is very unlikely to change confidence in the estimate of effect; B recommendation is based on moderate quality evidence, and further research is likely to have an important impact in confidence in the estimate of effect; C recommendation is based on low quality evidence, such that further research is very likely to change the estimate of effect; D recommendation is based on very low quality evidence, and any estimate of effect is very uncertain.²¹ The strength of these recommendations were generated using only the references provided in the R3 report.