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Pain comes in pint sizes, too
While one pain assessment scale might work for adults, pediatric patients need a scale that’s suitable for their age. Therefore, many pediatric units implement the use of a scale that is designed to assess pain at each particular developmental level.
For example, at Phoenix Children’s Hospital, there are several tools:
• CRIES - Crying; Requires oxygen for Sat>95; Increased vital signs; Expression; Sleepless. Scale is used for infants from zero to 5 months;
• FLACC - Face-Legs-Activity-Cry-Consolabil-ity - scale for patients 2 months to 4 years as well as children with developmental delay and cognitive impairment of three years or less;
• FACES - series of happy to sad faces - scale for children 3 years or older;
• the number scale [zero to 10] for patients 10 years or older.
While the FACES and numeric pain scale also are used for older children at Children’s Health-care of Atlanta, the Objective Pain Scale, similar to FLACC, is used to assess pain in preverbal or nonverbal children. The emergency department uses FLACC for this age group because they often need a quick, triaged decision, and it suits this type of environment better, says Kathy Ordelt, RN, patient and family education coordinator at the pediatric facility.
Pain in infants is difficult to measure
Currently, Phoenix Children’s Hospital is conducting a pilot study with the Neonatal Infant Pain Scale as a possible replacement for CRIES. "The only complaints that staff have about the use difficulty of pain scales have been about the CRIES scale and the validity of application to the acuity level and diagnosis of many of our infants," says Susan Ohton, RN, BSN, a clinical educator at the pediatric facility.
The initial training in the use of the pain scales for nursing staff at Phoenix Children’s Hospital took place at a series of open-house poster presentations with handouts. Staff with expertise on the use of the pain scales were available at the open house to answer questions. "Upon completion of a post-assessment questionnaire, the participant received badges with FLACC on one side and CRIES on the other, and an algorithm that could attach to the badge. They also received a pin with the FACES scale," says Ohton. A self-learning module was created for the nurses who could not attend the open house. n
For more information about pediatric pain scales and their use, contact:
• Susan Ohton, RN, BSN, Clinical Educator, General Pediatrics, Phoenix Children’s Hospital, 909 E. Brill St., Phoenix, AZ 85006. Telephone: (602) 239-3492. E-mail: Sohton@phxchildrens.com.