THE UNIVERSITY OF TOLEDO

MEDICAL CENTER
Title: PAIN MANAGEMENT
Responsibility: Registered Nurse (RN)
Nursing Service
Nursing Guideline
Purpose: To provide adequate pain control and improve the quality of life for those experiencing pain.
Specific Notes: When pain is experienced, the body reacts with a complex physiological response: heart rate
quickens, respiration increases, muscles tense, and hormones are released. Should pain persist
and remain unchecked, these physiological effects can put a strain on an individual's health
and well-being.
Procedure
1. Assess for pain and discomfort upon arrival to the
nursing unit/service and every shift.
Pain assessment is performed more frequently as
needed per patient.
Pain will be reassessed after interventions to ensure
patient comfort and documented no later than the
end of the shift.
If pain intervention is provided within one hour of
end of the shift the next shift will be responsible for
documenting the reassessment.
2. Utilize the appropriate rating scale for the
individual being assessed.
Rating scale is to be selected based on patient.
Rating scales for adults may include: Visual analog
scale; the 0-1 0 pain rating scale; the Wong Baker
Pain Faces Scale; Adult nonverbal pain scale.
The FLACC rating scale may be used for children
and adults.
Assess location, duration, description, precipitating
and alleviating factors, and effects on activities of
daily living (ADL).
3. Educate patient on the following:
Importance of using a standardized tool.
Importance of open communication.
Patients right to pain control measures.
Effects of pain not properly managed on
recovery.
Address concerns of addiction.
Expected benefit from pain medication.
Expected side effects from pain medications.
Point of Emphasis
Maintain pain control at a level acceptable to the patient.
Determine the patient's pain goal and document in the
patient's electronic admission medical record.
Assessment of pain for patients with an epidural or
intravenous (IV) patient controlled analgesic (PCA) will be
completed according to the Guidelines established.
Take into consideration the patient's age, mental status,
cognitive and communication abilities and any co-
morbidity when choosing a scale.
As the interpretation of pain and how it is experienced is
subjective, it can be a difficult symptom to assess;
therefore, a complete assessment must be obtained.
The University of Toledo Medical Center has determined
that pain rated at '0' is no pain, 1-3 to be mild, 4-7 to be
moderate, and 8-10 to be severe.
The patient is an important part of the team and must
recognize his/her responsibilities and rights.
Pain medications should decrease, but may NOT alleviate
pain completely; therefore, realistic goals should be
fostered.
Side effects include: constipation, sedation, nausea/
vomiting, pruritis, hallucinations, confusion/delirium and
respiratory depression.
1. Dosage regimens are dependent on both
Pain Management Guidelines
Page 2 of3
Procedure
4. Consider patients medical history and condition in
relation to pain therapy.
5. Implement measures to reduce discomfort according
to physician orders: stagger them to receive a more
consistent level of control.
Medication orders that include a range order,
(or pain medication, will be administered
according to the standards established in
policy 3364-133-17 Medication Control and
Distribution.
Administer pain medications proactively, such
as before a dressing change, procedures, or
therapy.
Decrease negative environmental stimuli.
Teach and assist in relaxation techniques.
Utilize non-pharmacological interventions.
Administer pain medication promptly.
If multiple pain meds are ordered be sure to
6. Call light within reach.
7. Notify physician if above interventions are
ineffective.
8. Document assessment/reassessments, interventions,
effectiveness, and patient education in the patient's
medical record.
Point of Emphasis
pharmacokinetic and pharmacodynamic factors and may
change with age, chronic disease states and other
concurrent medications.
2. Take into consideration patients with history of sleep
apnea, respiratory disease, renal disease, liver disease and
age (pediatric patients and elderly patients) when ordering
and administering dose.
Diversonal activities and relaxation technique
aid in pain reduction.
The use of cold applications may be very effective in
decreasing procedural pain.
Repositioning can be used to decrease spasm and stiffness.
Dosage should be started at the lowest level and increased
as needed.
Medication by mouth should be the first route of
medication selected.
Documentation ofeffects, either positive or negative,
should be entered in the patient's medical record.
Oral and intravenous pain medications may be
administered simultaneously when a physic an order is
present indicating this and the pain level is 8 or greater,
respiratory rate> or =10, level o[consciousness is
arousable and capable of.(ollowing simple commands.
Common scenarios whre concurrent IV/PO therapy may
be appropriate include:
I. Oral narcotics administered while IV therapy is
still in use to facilitate the weaning of. the IV
therapy.
2. Oral therapy is adequate to manage pain but
occasional IV therapy is necessary to manage
break-through episodes of.pain.
Utilize the chain of command up to the attending physician
if necessary.
Document physician contacted, any change in medication
orders or new plan of care received (e.g. Consult pain
management) in patients medical record.
Reassessment should include whether the patient's goal
for pain relief was met (for example, pain intensity, effect
on function [physical or psychosocial]), patient satisfaction
with pain relief, whether side effects had occurred and
were tolerable.
Pain Management Guidelines
Page 3 of3
Revised by: M. Cathy Benninghoff, MSN, RN, CNS; & Greg Shannon, MSN, RN.
Approved: 2/2005
Reviewed: 7/2011
Revised: 7/2007, 1/08, 8/08. 3/2/11, 6/24/11, 7/14/11, 3/14
Reviewed by Policy & Standard Committee 2/2011, 6/11, 7/11
References: Carr, E., Meredith, P., Chumbley, G., Killen, R., Prytherch, D. R., & Smith, G. B. (2014). Pain: A
quality of care issue during patients' admission to hospital. Journal of Advanced Nursing, 70(6), 1391-
1403.
Perry, A.G., Potter, P.A., Ostendorf, W.R. (2014). Clinical nursing skills & techniques (8th ed.). St.
Louis: Mosby.
Mosby Nursing Skills. Retrieved on March 10, 2014, from
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