Model Pain Policy

Model Pain Policy

Department(s): Hospitalwide

Effective Date:

Policy Title: Pain Assessment, Reassessment and Treatment

Review Dates:

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SCOPE AND INTENT

This policy addresses the assessment and reassessment of pain in all settings throughout the organization. When pain is identified, the patient shall be treated or referred for treatment as clinically pertinent.

POLICY:

1.  All patients admitted as inpatients and presenting to the emergency department shall be questioned as whether or not they are experiencing pain. Other ambulatory patients need not be assessed for the presence of pain unless a) pain is commonly associated with the condition for which they are seeking care or b) pain may be induced by subsequent treatments or interactions (for example, patients undergoing an outpatient invasive procedure or potentially painful therapy.)

2.  An age and ability-appropriate comprehensive initial pain assessment shall be conducted for any patient reporting or suspected of having moderate or severe pain. The comprehensive assessment shall include, to the extent relevant, intensity (using an age-appropriate pain scale when practical and available[1]), site(s), quality (e.g. dull, sharp, throbbing, stabbing), radiation, onset (e.g. when did the pain start, is it increasing or decreasing). The details of the initial pain assessment may vary depending on the clinical presentation and the nature of the interaction. For example, a physician’s note addressing the patient’s pain as part of medical screening or a physical examination is considered a comprehensive pain assessment.

3.  A reassessment for the presence and intensity of pain shall be performed at least once every 12 hours for inpatients and extended-stay outpatients and following any intervention intended to lessen the patient’s pain (for example, administration of pain medications, application of cold packs, repositioning).

a.  Such reassessment shall take place within a clinically appropriate time frame, such as within an hour of the administration of oral medications or within a half hour of the administration of intramuscular or intravenous pain medications.

b.  It is NOT necessary that the results of such post-intervention reassessment be documented in a concurrent note. For example, the caregiver may document the reassessment of a successful pain intervention at the end of the shift and the documentation may be as simple as “patient sleeping comfortably following pain medication.”

4.  Patients, and, when appropriate, family members, shall be educated in their role(s) in managing pain and the potential limitation and side effect of pain treatments.

[1] Pain scales have been adopted for pre-verbal infants, children and verbal adults. Validated pain scales are not currently available in the literature for non-verbal and non-communicative adults.