CLINICAL GUIDELINE FOR THE ASSESSMENT AND DOCUMENTATION OF PAIN (ADULTS) 1. Aim/Purpose of this Guideline 1.1. Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does (MaCaffery and Beebe 1994). It is the responsibility of every healthcare professional to assess a patient s pain using a recognized pain scoring tool to provide effective and timely pain relief. 1.2. When to score pain: On admission and then daily unless: 1.2.1. Pain is a documented problem and then the frequency needs to be increased. 1.2.2. The patient is undergoing a procedure or treatment which has the potential to cause pain. 1.2.3. The patient reports unexpected or increased pain. 1.2.4. The patient has a method of pain relief such as an epidural or patient controlled analgesia, which uses a specific Trust protocol. 1.2.5. The patient is transferred to another ward/unit. 1.3. How to score pain: 1.3.1 Pain should be measured using the verbal descriptor scale: 1.3.2. S = Sleeping 0 = No pain 1 = Mild pain 2 = Moderate pain 3 = Severe pain 1.3.3 These measurements should be taken and recorded on rest and movement and recorded on the National Early Warning Score (NEWS) chart. It does not form part of the early warning system bit it is a vital component of total patient assessment. 1.3.4 Patients who are unable to verbalise their pain please contact the Pain specialist nurses to discuss alternative pain scoring tools. 1.3.5 For patients with specific pain relieving methods such as epidural/intrathecal infusions and patient controlled analgesia (PCA) refer to the guidelines on RCHT document library: http://intra.cornwall.nhs.uk/documentslibrary/royalcornwallhospitalstrust/clinical/pain/ EpiduralInfusions.pdf http://intra.cornwall.nhs.uk/documentslibrary/royalcornwallhospitalstrust/clinical/pain/ PatientControlledAnalgesia.pdf 1.3.6 Patients whose pain scores are persistently 2 or 3 (moderate or severe) despite regular administration of appropriate analgesia should be referred for specialist pain advice. 1.3.7 For referral to the Pain Team please refer to: http://intra.cornwall.nhs.uk/documentslibrary/royalcornwallhospitalstrust/clinical/pain/pain ServicesReferral.pdf Page 1 of 6
2. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared That pain assessment complies with the recommendations with the guideline Acute pain team Checking of patients with epidurals and PCA infusions will be carried out by the Pain specialist nurses and recorded on MAXIMS. Audit of NEWS charts Audit of NEWS charts to carried out 3 yearly. Pain specialist nurse checks on routine post operative checks. Results of the audit will be shared with mangers of audited areas and the Pain Team. The Pain team and relevant ward areas will undertake subsequent recommendations and action planning for any or all deficiencies and recommendations within reasonable timeframes. Required changes to practice will be identified and actioned within 6 months. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders 3. Equality and Diversity 3.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website. 3.2. Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 2 of 6
Appendix 1. Governance Information Document Title Date Issued/Approved: 13/10/15 Date Valid From: 13/10/15 Date Valid To: 13/10/2018 Directorate / Department responsible (author/owner): Contact details: 01872 252095 Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Clinical guideline for the assessment and documentation of pain (adults) Jayne Thomas Pain Specialist Nurse Guidance for effective assessment and documentation of pain. Pain assessment; pain scoring; pain tools; Pain documentation RCHT PCH CFT KCCG Medical director Date revised: October 2015 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional confirming approval processes Name and Post Title of additional signatories Name and Signature of Divisional/Directorate Governance Lead confirming approval by specialty and divisional management meetings Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Related Documents: Clinical guideline for the assessment and documentation of pain (adults) Pain Department; Pain consultants and Pain specialist nurses. Duncan Bliss Dr Rob Searle {Original Copy Signed} Name: Dr Rob Searle {Original Copy Signed} Internet & Intranet Pain Page 3 of 6 Intranet Only Holdcroft, A and Jagger,S (2005) Core topics in pain. Cambridge. Cambridge university press. McCaffery,m. Beebe,A (1994) Pain clinical manual for Nursing Practice. St Loius. MO. Mosby
Melzack,R and Wall, PD (eds) (2003) Handbook of pain management: A clinical companion to Wall and Melzack s textbook of pain. Edinburgh. Churchill Livingston. Training Need Identified? Yes. Pain department study days are available. Training for healthcare support workers carried out during core skills assessment. Version Control Table Date Version No 10 Jun 10 V1.0 Initial Issue Summary of Changes 1 Feb 11 V2.0 Addition of Monitoring Compliance table. 15 Jan 12 V2.1 5 Aug 13 V2.2 Governance information moved to an appendix. EIA updated. Governance information amended to align with format of Updated governance information table to include KCCG. 13 Oct 15 V2.3 Information put into new format. Changes Made by (Name and Job Title) Jayne Thomas. Pain CNS All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line. Page 4 of 6
Appendix 2. Initial Equality Impact Assessment Form Directorate and service area: Is this a new or existing Policy? Theatres and anaesthetics Existing Name of individual completing Telephone: 018722095 assessment: Jayne Thomas 1. Policy Aim* To provide guidance for staff to perform assessment of pain and to Who is the strategy / document it. policy / proposal / service function aimed at? 2. Policy Objectives* Effective pain assessment 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? Effective pain control for patients Random review of NEWS charts on a 3 year basis. Report from hospital patient satisfaction survey. Patients and staff Yes b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. Pain consultant and pain specialist nurses. Acute pain meeting. See above. 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Page 5 of 6
Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. Consultation had already been done and this was only a reformatting of data. Signature of policy developer / lead manager / director Jayne Thomas Date of completion and submission 13/10/2015 Names and signatures of members carrying out the Screening Assessment 1. 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 6 of 6