National Neonatal Surgical Benchmarking Group
Management of Pain (2012)
Practitioner agreed patient focused outcome:
All infants will remain pain free by providing them with an individualised plan
of care according to their needs. The effectiveness of strategies used are
assessed and documented within the multidisciplinary team
Indicators / information that highlights concerns which may trigger the need for
benchmarking activity:
Patient satisfaction surveys.
Complaints figures and analysis.
Critical incident analysis.
Documentation audit.
Research critique / trial.
FACTOR
BENCHMARK OF BEST PRACTICE.
1
Pain assessment
A reliable and validated pain assessment tool which is
appropriate to the individual infant is used and the results
consistently acted upon.
2
Management of Pain
Pain is assessed and managed by non-pharmacological
and pharmacological means according to individual
needs.
3
Equipment and resources
There are adequate resources to provide the necessary
pain relief.
4
Staff education
Patients are cared for by staff that have up to date and
relevant knowledge in pain management with clinical
expertise. Education is evidence – based,
comprehensive and consistent.
5
Parental education and
support
Parents are provided with appropriate information
regarding pain management.
NAME OF UNIT:
NAME OF PERSON (S)
COMPLETING BENCHMARK
Factor One: Pain assessment
PROHIBITIVE BARRIERS
BEST PRACTICE
A reliable and validated pain assessment tool
which is appropriate to the individual infant is
used and the results consistently acted upon.
Ref: American Academy of Pediatrics. (2006) Prevention and management of pain and stress in the
neonate. ‘ To evaluate and reduce stress and pain experienced by neonates, validated measures and
assessment tools must be used consistently. The assessments should continue as long as the neonate
requires treatment for pain or stress.’
Yes
Developing
No
2
1
0
INDICATORS OF BEST PRACTICE
A validated pain assessment tool is used:
The choice of tool takes into consideration
Gestational age,
Requirements for ventilatory support
Levels of sedation / paralysis
Severity of illness
Physiological responses :
Heart rate,
Respiratory rate,
Blood pressure,
Colour
oxygen saturation
Behavioural responses:
Facial expressions
Movement and posture
Verbalisation / cry
The appropriateness and effectiveness of pain management is
monitored through audit.
There are Unit guidelines indicating:
How to use the assessment tool
Frequency of the observations
Referral pathways
Roles of the multidisciplinary team
Range of treatment options
Score
Factor 1
□
□
□
□
□
0-1
E
2-3
D
4-6
C
7-8
B
9-10
A
Factor Two: Management of Pain
PROHIBITIVE BARRIERS
BEST PRACTICE
Pain is assessed and managed by nonpharmacological and pharmacological means
according to individual needs.
Ref: American Academy of Pediatrics. (2006) Prevention and management of pain and stress in the
neonate. ‘ Health care professionals should use appropriate environmental, non-pharmacological
(behavioural), and pharmacological interventions to prevent, reduce, or eliminate the stress and pain of
neonates’
Yes
Developing
No
INDICATORS OF BEST PRACTICE
2
There are Evidence based guidelines to support the use of Non
nutritive sucking.
There are Evidence based guidelines to support the use of
Swaddling and containment
There are Evidence based guidelines to support the use of
Kangaroo care
There are Evidence based guidelines for the use of Sucrose
There are Evidence based guidelines for the administration of
medicines such as opioids, non opioids and local anaesthesia.
Appropriate documentation for the prescribing is available.
Appropriate documentation for the recording of drug
administration.
Appropriate documentation evaluating the effectiveness of
treatment is available.
Documentation and record keeping is audited regularly. C9
Score
Factor 2
□
□
□
□
□
0-1
E
2-5
D
6-11
C
12-16
B
17-18
A
1
0
Factor three: Equipment and resources
PROHIBITIVE BARRIERS
BEST PRACTICE
There are adequate resources to provide the
necessary pain relief.
Ref: McKechnie L, Levene M (2008). Procedural pain guidelines for the newborn in the United
Kingdom. Journal of Perinatology. 28: 107-111
Yes
Developing
2
1
No
INDICATORS OF BEST PRACTICE
Environmental resources – To reduce stress from noxious
stimuli e.g. acoustic, visual, tactile and vestibular.
 Incubator covers, dimmer switches
Educational resources – are available to increase the skills of
the MDT in the assessment and management of pain and stress
in neonates.
The Neonatal team has access to a Specialist Pain team
There is a nominated pain link nurse
Non pharmacological resources –
A sufficient supply of dummies for non nutritive sucking is
available in a range of sizes following parental consent for use.
Equipment to support breastfeeding and the expressing of breast
milk is available.
A range of soft blankets and positioning equipment is available to
support and contain the infant
Pharmacological resources –
CIVAS service is available.
Staffing resources to facilitate audit –
The Unit has access to a Audit department / audit leads to
facilitate the correct design of an effective audit tool and its
implementation.
Score
Factor 3
□
□
□
□
□
0-1
E
2-5
D
6-10
C
11-14
B
15-16
A
0
Factor four: Staff Education
PROHIBITIVE BARRIERS
BEST PRACTICE
Patients are cared for by staff that have up to
date and relevant knowledge in pain
management with clinical expertise. Education
is evidence – based, comprehensive and
consistent.
Ref: ‘Clinical staff should receive training in the prevention, assessment and control of children’s pain”.
DoH, (2003) Getting the right start: NSF for Children. Standard for Hospital Services; pain management
4.33.
Standards for Better Health (2004) C5: Clinical care and treatment are carried out under supervision
and leadership: clinicians continuously update skills and techniques relevant to their clinical work: and
clinicians participate in regular clinical audit and reviews of clinical services.
American Academy of Pediatrics. (2006) Prevention and management of pain and stress in the neonate.
‘Educational programs to increase the skills of health care professionals in the assessment and
management of stress and pain in the neonate should be provided’
Yes
Developing
No
2
1
0
INDICATORS OF BEST PRACTICE
The competence of all staff regarding pain management is
assessed and evaluated on a regular basis.
There is a database to record staff training & assessment
Education and training resources for staff are evidenced based
and regularly reviewed.
Appropriate experts are available within the organisation to
provide ongoing education & training to the Multidisciplinary team.
Score
Factor 4
□
□
□
□
0-1
D
2-3
C
4-6
B
7-8
A
Factor five: Parental Education and involvement
PROHIBITIVE BARRIERS
BEST PRACTICE
Issues of pain management are discussed with
the parents at the first opportunity and they are
made aware of the pain cues of their individual
infants.
Parents are provided with appropriate
information regarding pain management and
are made to feel an integral part of the
decision making process involving pain
management
Ref: Riddell P et al (2011). Non pharmacological management of infant and young child procedural
pain (Review). Iss.10. http://www.thecochranelibrary.com
Yes
Developing
No
2
1
0
INDICATORS OF BEST PRACTICE
A parental information leaflet on pain is available
The information is :
1) evidenced based. (Specify source and review process)
2) user friendly & understandable to the family.
3) Is it in a format that the family can access. (Fact sheets,
leaflets, videos, translated materials)
Parental understanding / acceptability of the information is
assessed and documented.
The information meets the Core Standard C16 as set out in the
Standards for Better Health. (Patient focus and accessible
information).
Cultural / ethnic / linguistic needs are addressed.
Parents have the opportunity to discuss pain management with
the MDT.
There is a Pain management liaison nurse to support parental
understanding.
Score
Factor 5
□
□
□
□
□
0-1
E
2-4
D
5-7
C
8-10
B
11-12
A
Action planned to move towards best practice statement
Compiled by
Unit:
Date:
Aim:
Action required:
By whom:
Date to be
completed:
Reflection / comment