1. Laurie Soper MS, MSN, APRN -C Acute Care Clinical Education Specialist

2. 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

3. GPRMC has a strong commitment to Pain Management Our patients have a right to: Information about pain and pain relief A concerned staff committed to pain prevention and management Health professionals who respond quickly to reports of pain Health professionals who believe your report of pain State of the art pain management

4. Pain Assessment & Management Policy 6010-0007 Patient Controlled Analgesia Policy 6265 I L MED 002

5. 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)

6. 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

7. Wong Baker/Numeric Pain Scale FLACC Scale Adult Non Verbal Pain Scale N-PASS

8. 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

9. 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(faces) Scale FLACC PAIN ASSESSMENT SCALE O12 FACENo particular expression or smile Occasional grimace or frown, withdrawn, disinterested Frequent to constant frown, clenched jaw, quivering chin LEGSNormal position or relaxed Uneasy, restless, tense Kicking or legs drawn up ACTIVITYLying quietly, normal position, moves easily Squirming, shifting back and forth, tense Arched, ridged, or jerking CRYNo Cry (awake or asleep) Moans or whimpers, occasional complaint Crying steadily, screams or sobs, frequent complaints CONSOLABILITYContent, relaxedReassured by occasional touching, hugging, or “talking to”; distractible Difficult to console or comfort Face Legs Activity Cry Consolability

10. For adults that are unable to self report their level of pain for whatever reason (critically ill, intubated, sedated, comatose, confused Categories012 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 I Stable vital signs (no change in past 4 hours) Change over past 4 hours if any of the following: SBP>20mmHG HR>20/min RR>10/min Change over past 4 hours in any of the following: SBP>30mmHG, HR>25/min, RR>20/min Physiological II Warm, dry skinDilated pupils, perspiring, flushing Diaphoretic, pallor

11. A behavioral assessment tool for measurement of pain in preterm and full-term neonates.

12. Document pain assessment at minimum every shift Documentation can be completed: Vital Sign Flowsheet Hourly Patient Rounding Flowsheet Shift Assessment Flowsheet Ensure document correct scale use for pain assessment

13. All patients should be educated on pain during admission and throughout their hospital stay Education is the key to successful pain management

14. Questions ??