Nipps, Pipps, N-pass....

[prmenrs]

re-evaluating our flow sheet, including the pain scale.

does anyone use a pain scale other than nipps, pipps, or n-pass?

thanks for your help!!

[dawngloves, BSN, RN]

Worked like a charm, and all of our babies get pain scores Q1H now - even those grower-feeders. We do it for everyone. Plus when we handle the baby, we also give them a sedation score to assess how they react to stimulation. This is using the N-PASS scale. Pain scores are positive numbers, sedation is negative numbers.

Q hour? Really? On feeder growers we do Q6 and otherwise Q3, unless there is a change or a prn is given. Not like it would kill me to write 0 in a column.

Can I butt in on your thread prmenrs? How often do any of you do NAS? Our docs can never come to an agreement and we get orders all over the place.

[Gompers, BSN, RN]

Q hour? Really? On feeder growers we do Q6 and otherwise Q3, unless there is a change or a prn is given. Not like it would kill me to write 0 in a column.

Can I butt in on your thread prmenrs? How often do any of you do NAS? Our docs can never come to an agreement and we get orders all over the place.

We do them Q1H because it just makes things fool-proof. It's so easy, why not do it, we figure.

We do NAS whenever we handle a baby. With a micropreemie it might be Q6H, with a feeder-grower it's usually Q3-4H with feedings.

[prmenrs, RN]

What do you mean by NAS? Not familiar w/that acronym.

[dawngloves, BSN, RN]

Neonatal Abstinence Scoring. For charting withdrawl symptoms. You're kinda "old school" so maybe you know it as Finnegan Scoring.

(Not saying you're old :kiss just it was called something else)

[prmenrs, RN]

Well, as it turns out, I am old! Wanna make something outta it??? kidding, just kidding!

I always just called them abstinence scores. We didn't have any set intervals for doing them, just every assessment/vs time.

[elizabells, BSN, RN]

I'll try to remember to find out today if we use anything for the pain score. It may be that my preceptor is just so experienced (25+ years in this NICU) that she just sort of intuits it.

[elizabells, BSN, RN]

Okay, I guess we just use our "comfort assessment" scale as a pain scale as well. As stated before, it rates gestational age (corrected), facial expression, BP, HR, and sat changes with handling. Oh, also consolability and flexion/movement.

[Mags4711, RN]

Pain scoring is HUGE with JCAHO now. This past year we were being audited on an institutional level about pain scoring, prior to our JCAHO visit.

Well, I learned that:

1) Pain in a stable infant who has no indwelling lines/tubes that should cause pain needs to be assessed once per 8hr shift.

2) Pain in a post-op patient or a patient with indwelling lines should be assessed a minimum of every 4 hrs.

3) If on a drip, initially every hour, then every four hours when stable.

4) Everytime a medication or pain relieveing intervention is given/performed, and then one hour later.

We actually started getting pulled into the office and getting reprimand letters in our files if we didn't score our patients correctly. Especially if we gave a med and did not record a score.

That didn't last that long. Apparently it wasn't a kosher thing to do.

So we started scoring our kids every hour even if they were feeder growers so that we wouldn't get in trouble.

[Mags4711, RN]

Oh yes, we use N-PASS

[elizabells, BSN, RN]

Okay, so this is weird. We use Nipps in the transitional nursery, where babies go after delivery but before NICU. But we use our own happy comfort assessment tool in the NICU itself. If the baby isn't in pain, we use the comfort assessment tool in the TN also. I'm so confused!