Laurie Soper MS, MSN, APRN -CAcute Care Clinical Education Specialist

Pain Assessment & Management

Identify the appropriate GPRMC policies and procedures related to pain assessment and management

Discuss the pain scales used at GPRMC (Wong- Baker, FLACC, Adult Non-verbal, & NIPS)

Demonstrate knowledge by completing the post test with a score of 90% or more

Objective

GPRMC has a strong commitment to Pain Management

Our patients have a right to:

Information about pain and pain reliefA concerned staff committed to pain

prevention and managementHealth professionals who respond quickly

to reports of painHealth professionals who believe your

report of painState of the art pain management

Pain Management at GPRMC

Pain Assessment & Management Policy

6010-0007

Patient Controlled Analgesia Policy

6265 I L MED 002

Document the patient’s responses during the following:

At admission

After any known pain producing event

With each new report of pain

Routinely at regular intervals (at least every shift)

Pain Assessment

Pain shall be assessed and pain intensity documented within 60 +/- 15 minutes after parenteral drug therapy

Pain shall be assessed and pain intensity documented within 90 +/- 15minutes after oral drug therapy

Pain shall be assessed at a minimum every 4 hours during the first postoperative day following major surgery during the inpatient admission

Pain shall be assessed and pain intensity documented every 4 hours and PRN while patient has a PCA/PCE

Pain Assessment Cont.

Wong Baker/Numeric Pain Scale

FLACC Scale

Adult Non Verbal Pain Scale

N-PASS

Pain Scales

Wong-Baker/Numeric Scale

For children and adults who demonstrate the ability to use the scale by choosing a face or stating a number that indicates their pain level

For infants and children who are preverbal or children up to three years of age who are unable to use the Wong-Baker (faces) Scale

The FLACC Scale

FLACC PAIN ASSESSMENT SCALEO 1 2

FACE No particular expression or smile

Occasional grimace or frown, withdrawn, disinterested

Frequent to constant frown, clenched jaw, quivering chin

LEGS Normal position or relaxed

Uneasy, restless, tense

Kicking or legs drawn up

ACTIVITY Lying quietly, normal position, moves easily

Squirming, shifting back and forth, tense

Arched, ridged, or jerking

CRY No Cry (awake or asleep)

Moans or whimpers, occasional complaint

Crying steadily, screams or sobs, frequent complaints

CONSOLABILITY Content, relaxed Reassured by occasional touching, hugging, or “talking to”; distractible

Difficult to console or comfort

FaceLegsActivityCryConsolability

For adults that are unable to self report their level of pain for whatever reason (critically ill, intubated, sedated, comatose, confused

Adult Non Verbal Pain Scale

Categories 0 1 2

FACE No particular expression or smile

Occasional grimacing, tearing, frowning, wrinkled forehead

Frequent grimace, tearing, frowning, wrinkled forehead

ACTIVITY(Movement)

Lying quietly, normal position

Seeking attention through movement or slow, cautious movement

Restless, excessive activity and/or withdrawal reflexes

GUARDING Lying quietly, no positioning of hands over areas of body

Splinting areas of body, tense

Rigid, Stiff

PHYSIOLOGIC IStable vital signs (no change in past 4 hours)

Change over past 4 hours if any of the following: SBP>20mmHGHR>20/minRR>10/min

Change over past 4 hours in any of the following:SBP>30mmHG,HR>25/min,RR>20/min

Physiological II Warm, dry skin Dilated pupils, perspiring, flushing

Diaphoretic, pallor

Neonatal Infant Pain Scale (NIPS)A behavioral assessment tool for measurement of pain in preterm and full-term neonates.

Document pain assessment at minimum every shift

Documentation can be completed:Vital Sign FlowsheetHourly Patient Rounding FlowsheetShift Assessment Flowsheet

Ensure document correct scale use for pain assessment

Documentation

All patients should be educated on pain during admission and throughout their hospital stay

Education is the key to successful pain management

Education

Questions ??