Newborn Pain Assessment

1. How often does your facility require that you do pain assessments on well newborns?
2. 

   About darynash

   Joined: Jan '06; Posts: 69; Likes: 10

   10 Comments

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3. 
   Dec 28, '06

   Occupation: L&D RN Specialty: 23 year(s) of experience in L&D- Mother/Baby ; Joined: May '06; Posts: 115; Likes: 4

   Though we don't have a written policy, we do a pain assessment q shift and as needed, like when a circumcision is done.
4. 
   Dec 28, '06

   Occupation: Nurse of course! Specialty: NICU, PICU, educator ; From: US ; Joined: Feb '04; Posts: 1,838; Likes: 1,115

   All kids get a pain score at least once a shift, more frequently if procedures are being done.
5. 
   Dec 28, '06

   Occupation: Nurse Educator Specialty: 16 year(s) of experience in Gerontological, cardiac, med-surg, peds ; From: US ; Joined: Mar '01; Posts: 12,037; Likes: 6,468

   At our clinical facility (a magnet-status regional teaching hospital), we perform pain assessments with each set of vital signs (pain is considered the 5th vital sign) and PRN.
   
   We use the following pediatric pain scales for infants/ neonates:
   
   P.A.T. (Pain Assessment Tool) - for use in infants through 9 months of age
   Parameters: Posture/ Tone, Sleep Pattern, Facial Expression, Cry or "Silent Cry," Skin Color, Respirations, Heart Rate, Oxygen Saturation, Blood Pressure, Caregiver "Perception"
   
   Score < 5 = NO PAIN
   Score 5-10 = Comfort intervention and reassess
   Score > 10 = Consider medication and reassess
   
   FLACC Behavioral Pain Assessment Scale - for use in infants > 9 months, toddlers, pre-schoolers, and children unable to understand the concept of the 0-10 scale or the Faces Scale.
   Parameters: Face, Legs, Activity, Cry, Consolability
   
   Score 0-5 = Comfort measures and reassess
   Score > 5 = Pharmacologic interventions
   
   PEPPS - Preverbal, Early Verbal Pediatric Pain Scale - used in infants > 9 months, toddlers, pre-schoolers, and children unable to understand the concept of the 0-10 scale of the Faces Scale
   Parameters: Heart Rate, Facial, Cry (Audible/ Visual), Consolability/ State of Restfulness, Body Posture, Sociability, Sucking/ Feeding
   
   Score 0 = Comfort Zone
   Score 1-9 = Nonpharmacologic Interventions
   Score >9 = Use clinical judgment to determine nonpharmacologic and/or pharmacologic interventions
   
   COMFORT Pain Scale - used for the intubated, non-paralyzed patient
   Parameters: Alertness, Calmness/ Agitation, Respiratory Response, Physical Movement, Blood Pressure (MAP) Baseline, Heart Rate Baseline, Muscle Tone, Facial Tension
   
   Score 20-26 = Comfort measures and reassess
   Score > 26 = Pharmacologic interventions
   
   Hope this helps

   Last edit by VickyRN on Dec 28, '06
6. 
   Dec 29, '06

   Joined: Nov '06; Posts: 20,715; Likes: 23,949

   Qshift or when they have a painful procedure done such as circ, injections, or heelsticks.
7. 
   Dec 29, '06

   Joined: Apr '02; Posts: 38,762; Likes: 16,341

   We are required to do this with our shift assessments, so at least qshift, or more often as needed.
8. 
   Dec 30, '06

   Occupation: Postpartum staff RN Specialty: 5 year(s) of experience in Postpartum, Lactation ; Joined: Mar '04; Posts: 129; Likes: 21

   Q shift and with painful interventions. We use NIPS.
9. 
   Jan 7, '07

   Occupation: Nursery I & II Specialty: 20+ year(s) of experience ; Joined: Oct '06; Posts: 441; Likes: 97

   We use NIPS as '5th vital sign' (with all vitals) and with any procedures (circ, blood draw, etc.).
10. 
    Jan 7, '07

    Joined: Dec '04; Posts: 11,695; Likes: 14,915

    We use NIPS q shift, with painful procedures (and 24 hours post-circ), AND with any sign of protracted fussiness or inconsolability. A kiddo can have a whopper bellyache from swallowed fluid, formula intolerance, inadequate burping, etc. A baby that is hard to comfort or can't be comforted needs a thorough eval, including assessment for possible withdrawal issues.
    
    Worst case would be something like testicular or intestinal torsion or other problems that are equally distressing and difficult to spot in a routine newborn exam.
    
    Inconsolability (beyond mere fussiness) should set off alarm bells and initiate further investigation.
11. 
    Jan 10, '07

    Joined: Oct '04; Posts: 5,969; Likes: 1,404

    q 4 hours, or more often as needed .... and we use NPAT
12. 
    Jan 11, '07

    Occupation: Neonatal Nurse Practitioner Specialty: 9 year(s) of experience in Neonatal ICU (Cardiothoracic) ; From: US ; Joined: Apr '05; Posts: 3,517; Likes: 1,700

    Q2-3-4, (whenever we do VS and/or feeds) with procedures, etc. We use the NPASS scale.

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