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Use of Pain Tools for Pain Assessment Sherry Nolan MSN, RN 2009

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Title: Golden rule of Neonatal Pain management Author: Laura Klee Last modified by: snolan Created Date: 1/5/1980 4:53:12 AM Document presentation format – PowerPoint PPT presentation

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Title: Use of Pain Tools for Pain Assessment Sherry Nolan MSN, RN 2009


1
Use of Pain Tools for Pain AssessmentSherry
Nolan MSN, RN2009
  • FACES, FLACC, and N-PASS--
  • The 3 Approved Tools for CHLA

2
Pain Assessment Background
  • American Pain Society - Quality Assurance
    Standards for Relief of Acute Pain and Cancer
    Pain.
  • Agency for Health Care Policy Research
    guidelines,1990
  • TJC The Joint Commission standards
  • All these agencies mandate the need for objective
    assessment and treatment of pain in all patients

3
JCAHO Standards Pain Assessment
  • The following must be included
  • Intensity, Location, Quality
  • Alleviating, Aggravating Factors
  • Pain history, treatment regimen effectiveness
  • Impact of pain on daily life

4
TJC Standards (Cont.)
  • Hospital commitment to pain management
  • Information about pain management provided to
    patient/families
  • Discharge plan for pain management

5
Pain Assessment Definition
  • McCafferys definition of pain whatever the
    experiencing person says it is, existing whenever
    he or she says it does.
  • Patient self-report measures are the gold
    standard
  • Healthcare providers and parents underrate
    childrens pain

6
Pain History
  • Starts with hx of pain episode
  • Includes onset location
  • Radiation and duration
  • Quality or description
  • Severity/intensity /frequency
  • Exacerbating/precipi-tating/alleviating factors
  • Impact on adl

7
Pain Assessment History
  • Admission Data Base
  • Must include info on current and past pain
  • Words used for pain
  • Should be clarified and documented for clarity
  • Note social, cultural spiritual influences that
    may affect the patients pain experience.
  • If pain is present on admission or at any time,
    implement the standardized MPC for acute
    pain.Dont forget the teaching section!
  • Separate MPC for SCD crisis/ teaching section

8
Pain Assessment History (Cont.)
  • When pain is present, always ascertain its
  • Quality
  • Intensity
  • Location
  • Aggravating Factors
  • Alleviating Factors

9
Pain Assessment Potential Causes of Pain
  • Preoperative/postoperative
  • Pain crisis
  • Acute, chronic, or episodic pain
  • Procedural pain
  • Other examples Th??????ink of your own
    examples.

10
Pain Assessment Pain Rating Scales
  • Goals
  • to identify intensity of pain
  • to establish a baseline assessment
  • to evaluate pain status
  • to evaluate effects of intervention
  • meeting professional,ethical, and regulatory
    requirements

11
Pain Assessment Pain Rating Scales
  • Before using a pediatric pain tool.
  • Assess developmental level
  • Can child verbalize pain?
  • Can child use pain rating scale?
  • Use the water test
  • Use the appropriate scale

12
Pain Tools approved for use at CHLA
  • FLACC
  • FACES
  • N-PASS
  • Verbal Self-report limited to the visually
    impaired

13
Pain Assessment Pain Rating Scales
  • FLACC scale has 5 categories
  • F Face
  • L Legs
  • A Activity
  • C Cry
  • C Consolability
  • For preverbal or nonverbal children from infancy
    to 7 years

14
Pain Assessment Pain Rating Scales
  • FLACC
  • Face Scoring
  • 0 no particular expression or smile
  • 1 occasional grimace or frown, withdrawn,
    disinterested
  • 2 frequent to constant quivering of chin,
    clenched jaw

15
Pain Assessment Pain Rating Scales
  • FLACC
  • Legs Scoring
  • 0 normal position or relaxed
  • 1 uneasy, restless, tense
  • 2 kicking, or legs drawn up

16
Pain Assessment Pain Rating Scales
  • FLACC
  • Activity Scoring
  • 0 lying quietly, normal position, moves easily
  • 1 squirming, shifting back and forth, tense
  • 2 arched, rigid, or jerking

17
Pain Assessment Pain Rating Scales
  • FLACC
  • Cry Scoring
  • 0 no cry (awake or asleep)
  • 1 moans or whimpers occasional complaint
  • 2 crying steadily, screams or sobs, frequent
    complaints

18
Pain Assessment Pain Rating Scales
  • FLACC
  • Consolability Scoring
  • 0 content, relaxed
  • 1 reassured by occasional touching, hugging or
    being talked to, distractible
  • 2 difficult to console or comfort

19
FLACC Scale
20
Pain Assessment Pain Rating Scales
  • Wong/Baker FACES Scale
  • For children aged 3 to young adults
  • Cartoon faces from 0 (no hurt) to 10
  • (hurts worst)
  • Use script to administer first few times
  • Now on white boards in all rooms

21
Pain Assessment Pain Rating Scales
  • Verbal Self-Report
  • For patients who are visually impaired only
  • Ask to rate pain on a scale of zero indicating
    no pain and ten indicating worst possible pain

22
Pain Assessment Pain Rating Scores and Treatment
  • Interventions are based on scores
  • Intervention for pain score of gt3
  • Reassess within 1 hour of intervention

23
Pain Assessment Policies and Procedures
  • Refer to Policy Procedure
  • Pain Management Assessment of Pain in
    Neonates, Infants, Children, Adolescents and
    Young AdultsCOP-8

24
Additional Web Links
  • Comparison of Pediatric Pain tool
  • Pediatric Pain Management U Mich

25
N-PASS

26
Golden Rule of Neonatal Pain Management
  • Pain should be presumed in all neonates in all
    situations that are usually identified as painful
    in adults or children
  • Pain treatment should be instituted in all cases
    where pain is presumed

27
Actual or potential causes of pain
  • Peritonitis
  • Fractures
  • Renal stones
  • Noxious environment
  • Damaged skin integrity
  • Surgical procedures
  • Invasive/indwelling tubes
  • Heelsticks
  • Arterial punctures
  • Suctioning

28
Neonatal Pain Tool
  • No Neonatal pain tool is perfect
  • Multidimensional pain tools that look at more
    than one sign of pain cry, behavior, vital sign
    changes, etc are preferred over unidimensional
    tools
  • The N-PASS Neonatal Pain, Agitation, and
    Sedation Scale will be used for all neonates lt
    44 weeks post-conceptual age.. Puchalski and
    Hummel, Loyola University Medical Hospital

29
For Pain Assessment
"0" no pain behaviors
30
Sedation Score
"0" no signs of sedation
31
Pain Interventions
  • Should be initiated for scores of gt 3
  • Some older infants may have an increased baseline
    score, interventions should then be instituted
    for consistent elevations.
  • Those weaning from opioids may have increased
    scores

32
N-PASS Idiosyncrasies
  • Premies are given up to 3 additional points based
    on their gestation
  • Pain and sedation scores are scored separately

33
Goals of pain treatment
  • The score should be lt 3 usually
  • Show a decrease in the pain score

34
Sedation Score
  • Scored to assess response to stimuli
  • Though sedation need not be scored with every VS,
    Sedation should be scored
  • With hands-on VS
  • When patients are on analgesics or sedatives
  • When stimulation of the baby is necessary, e.g
    heelsticks, suctioning, position changes
  • Baby should not be stimulated unnecessarily to
    assess the sedation score

35
N-PASS Sedation Score- Utility
  • When sedation of the infant is a goal
  • When sedation--or over-sedation-- is a side
    effect of analgesia or sedative administration

36
Levels of Sedation
  • Noted on N-PASS as negative scores
  • Desired levels vary based on treatment goals
  • Deep sedation avoided unless patient is on
    mechanical ventilation -10 to - 5
  • Light sedation -5 to 2

37
Negative sedation score interpretation
  • Sedation has been achieved or is a by product of
    medication administration
  • May also indicate neurological depression,
    sepsis, or other pathology
  • May indicate a pain response in a premie who is
    shut down in the face of prolonged or
    unrelieved pain or stress.

38
Continuous reassessment
  • Reassessment is key to successful pain management
  • Should occur on a routine basis after an initial
    report of pain after each intervention to
    document the effectiveness of the intervention.
  • Guides the continued care plan
  • Adjust p.m. regime to clinical reassessment
    findings understanding of pharmacology,
    non-pharm rx, the individual patient.

39
Customization, collaboration
  • Use a multimodal approach with regard to
    pharmacologic agents-peripheral central relief
  • Non-pharmacologic heat/coldrelaxa-tion
    techniquesdis-traction

40
Policies Procedures
  • COP 8, Assessment Management of Pain in
    Infants, Children Young Adults

41
Pain management is a patient right
  • Nurses must make a conscious commitment to
    support this right
  • It s good thing!
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