A.

POLICY:

 Pawana hospital documented policy & procedure for management of pain.

 All patients undergo pain screening & monitored for pain.
 When indicated such patients undergo detailed assessment.
 The organization respects & supports pain management; patient & family are
educated on various pain management techniques where appropriate.

B. PURPOSE:

 Pain management is an integral component of patient care.

 To provide guidelines for appropriate management of pain.

C. SCOPE :

D. PROCEDURE:

 Pain is considered as fifth vital sign.

 All patients during assessment are screened for pain in the Emergency Unit ,
OPD,IPD and daycare
 To assess pain score the Wong Baker Faces pain scale consists of graduated
facial expression of pain is used.
 It is used for patients ages 5-12 and those unable to comprehend the numerical
scale FACES scale shall be used.
 Faces Pain Scale is shown to the patient and explain the patient that each face is
for a person feeling pain in different severity.

Interpretation is as follows-
 0 = “very happy because he doesn’t have pain at all”
 2 = “the pain hurts just a little bit.”
 4 = “the pain hurts a little more.”
 6 = “the pain hurts even more.”
  8 = “the pain hurts a whole lot.”
 10 = “the pain hurts worst, as much as you can imagine.”
Ask the patient to choose the face that best describes how he feels.
Be specific about the “pain location” and “pain at present”.
For Pediatric patients(less than 5 years old), (FLACC) scale comprising of the Face,
Legs ,activity, Cry, Consol is used to assess pain score.

Pain monitoring
 Pain score is monitored in each shift by physician assistant.
 Also whenever patient complaints of pain again detailed reassessment is done
by the physician assistant. Whenever score is above four respected consultant is
reported and further orders are obtained.

Pain assessment- and management-

 A detailed pain assessment is done when the pain is the predominant (or one of
the main) symptoms and pain score in screening is 4 or above 4 e. g: in cancer,
arthralgia, neuralgia.
 This excludes chest pain due to angina or the etiology of pain is physiological like
labor pain.
 The detailed assessment is captured in separate form and treatment is prescribed
using WHO guidelines.
 Pain character, frequency, location, duration, referral or radiation is assessed and
documented.

VAS 1-3 /10: Mild Pain

Step 1- Non narcotic : round the clock.

Adjuvant if indicated.

Drug is prescribed oral or IV or IM as required.

VAS 4-6/10: Moderate pain

Step 2 – Add opioid for moderate pain- round the clock

Adjuvant if indicated
Drug is prescribed oral or IV or IM as required.

VAS 7-10/10: Severe pain

Step 3 - Start with strong opioid- round the clock.

Adjuvant if indicated

(Adjuvant therapy - medications that can help to enhance the effect of non opioid and
opioid analgesics.)

 Regional block/ nerve block therapy if indicated.

 Patients and family members are educated to various forms of pain management
techniques and promote competencies within are of pain management striving to
improve or enhance methodologies to control pain.

Post operative pain:

 To maintain freedom from pain, drug is given “by clock”, that is every 3-6 hours,
rather than “on demand”
 All post op patients are expected to have VAS score more than 4, hence started on
with combination of NSAIDs and Opioids.
 Patient vas score is monitored in each shift once and whenever patient complaints
pain.
 In spite of NSAID in place, when patient complains pain, pain score is reassessed. If
more than 4 call is given to surgeon/ intencivist.
 Further Drug is prescribed oral or IV or IM as required.
 Regional block / nerve block is advised by the consultant as per requirement

Family and patient education :

Educate patient/family at the level of their understanding of the following

 How and when to request interventions for comfort/symptom relief.

 Discharge planning addressing pain management whenever warranted by the
patient’s condition:
 Details in the discharge instructions, the interventions patients and families can
utilize to manage pain following hospitalization.
 Provide the name and telephone number of the individual to contact with
problems, such as excessive discomfort.
 The Clinician note may also include patient education regarding pain management.

E. RESPONSIBILITY:

Clinician Incharge, Anesthesiologist, Nursing staff, Medical officer.

F. RECORDS :

 Pain assessment forms

 Assessment forms