pain survey

Specialties Ambulatory


Does anyone out there have a working form to evaluate the effectiveness of pain control in the PACU(recovery room) on patients that are ambulatory services and also to be admitted?

Am working on developing a tool for our evidenced based practise and could use all the help I can get. Thanks


799 Posts

Specializes in Step down, ICU, ER, PACU, Amb. Surg.


We use a pain scale of 0-10. For children we use the smiley faces with the smile for 0 and the open mouth frown with tears for 10. We document the time, the med used for pain, the dose given, the pain scale value, inital it and then document the results. Also documented are the quality of pain, these valuse are all documented in a section, marked out in boxes with these values assigned to them, so it is fill in the blank basically. The pain scale and quality is evaluated along with vital signs, again in boxes assigned those values, so fill in the blank. A brief note is written to explain anything further. If you give me your email, I'd be happy to try and scan our PACU form for you and mail it to you, to give you some ideas. Hope this helps.



1 Post


We use the numerical score 0-10 also. For children/language barriers we use Whaley/Wong's facial scale. It's a facial scale from 0-5 smile to grimace with tears to show severity.Is your hospital associated with ASPAN? Check there recommended guidelines it will help. Cindy


613 Posts

Specializes in Psych, Informatics, Biostatistics.

we use the faces and the flacc scores for PEDs. These are measured from 0 to 10. We just implemented that prior to leaving the PDED the nurse must make a PAIN assessment. We are forcing them on the computer system to do the assessment.

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