Pain Management Flow Chart - Adventist Aged Care

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PAIN MANAGEMENT FLOW CHART
NAME: ________________________________________ DIAGNOSIS: _______________________________________________________
NON-
PAIN
PAIN MANAGEMENT
DATE
TIME
LOCATION
ACTIVITY
VERBAL
EVALUATION
SIGNATURE
RATING
INTERVENTION
CUE
PAIN RATING
ACTIVITY
NON-VERBAL INDICATORS
PAIN MANAGEMENT
1
Sleeping/resting
1
Groaning/crying out
1
Repositioning
2
Moving for personal care
2
Facial Grimaces/wincing
2
Medication
3
Passive exercise
3
Wrinkling of forehead
3
Hot/cold pack
0 No Pain
1 Mild Pain
2 Moderate
4
Active exercise
4
Increased restlessness
4
Aromatherapy
5
Toileting
5
Rocking
5
Massage
6
Sitting
6
Rubbing/guarding body parts
6
Exercise
7
Standing
7
Increased irritability
7
Diversion/distraction
3 Severe
4 Very Severe
5 Excruciating
8
Transferring/hoisting
8
Aggressive/resistive behaviour
8
Other
9
Other
9
Other
T:\Aged Care\Chrystal's Folder\Controlled Documents\Intranet Word\Forms\Clinical\F-10-CLIN Pain Flow Chart.docx
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Updated 25/09/02 V1

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