Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Recommendations

1.0 Assessment:

1.1 Screen for the presence, or risk of, any type of pain:
 -On admission or visit with a health-care professional;
 -After a change in medical status; and
 -Prior to, during and after a procedure.

1.2 Perform a comprehensive pain assessment on persons screened having the presence, or risk of, any type of pain using a systematic approach and appropriate, validated tools.

1.3 Perform a comprehensive pain assessment on persons unable to self-report using a validated tool.

1.4 Explore the person’s beliefs, knowledge and level of understanding about pain and pain management.

1.5 Document the person’s pain characteristics.

2.0 Planning:

2.1 Collaborate with the person to identify their goals for pain management and suitable strategies to ensure a comprehensive approach to the plan of care.

2.2 Establish a comprehensive plan of care that incorporates the goals of the person and the interprofessional team and addresses:
 -Assessment findings;
 -The person’s beliefs and knowledge and level of understanding; and
 -The person’s attributes and pain characteristics.

3.0 Implementation:

3.1 Implement the pain management plan using principles that maximize efficacy and minimize the adverse effects of pharmacological interventions including:
 -Multimodal analgesic approach;
 -Changing of opioids (dose or routes) when necessary;
 -Prevention, assessment and management of adverse effects during the administration of opioid analgesics; and
 -Prevention, assessment and management of opioid risk.

3.2 Evaluate any non-pharmacological (physical and psychological) interventions for effectiveness and the potential for interactions with pharmacological interventions.

3.3 Teach the person, their family and caregivers about the pain management strategies in their plan of care and address known concerns and misbeliefs.

4.0 Evaluation:

4.1 Reassess the person’s response to the pain management interventions consistently using the same re-evaluation tool.
The frequency of reassessments will be determined by:
 -Presence of pain;
 -Pain intensity;
 -Stability of the person’s medical condition;
 -Type of pain e.g., acute versus persistent; and
 -Practice setting.

4.2 Communicate and document the person’s responses to the pain management plan.