Employee Name: Date
Hospital:
Skill: Pediatric Pain Assessment and Management
Resources / Policy
& Procedures
A 10 yr. old female is admitted for abdominal pain. Morphine 1-2
Critical Thinking mg IV is ordered for severe pain. How would you verify that this is
Scenario an appropriate dose? What tools would you use to assess her pain?
Describe how you would assess her.
Skill Components: Completion Status
1. Reviews/completes:
a. Hospital’s Pain management policy
b. Pediatric medication competency validation
c. Pain assessment / Management competency validation
2. Verbalizes understanding of appropriate non-verbal scoring tools (ie,
FLACC)
3. Knows location of pediatric medication resource books (pharmacy or nurse’s
station)
4. Verbalizes knowledge of prescribed medication’s action, route of
administration, drug incompatibilities, adverse reaction and overdose
signs/symptoms.
5. Double checks IV medication dosage with another nurse.
6. Follows hospital PCA medication administration policy (if indicated)
7. Identifies age/developmental factors that influence pain assessment:
a. Infant:
i. Uses crying to indicate pain/discomfort, hunger, frustration
b. Toddler/Preschooler:
i. May not be able to verbalize pain / discomfort
ii. Concerned about the smallest injury
iii. Difficult to distinguish crying out of fear vs. pain
c.. Adolescent: May not want parent present for exams
8. Modifies pain assessment based on child’s age and developmental level
a. Uses age appropriate pain scales (neonatal, pediatric) to assist in
determining pain.
b. Provides age appropriate explanations for child.
c. Toddler – School age:
Ask child to point to location of pain / discomfort
Utilizes props (dolls, teddy bears, etc.) to determine location
d. Preschool - Adolescence: Uses simple and direct questions.
e. Adolescence: Provides privacy and respects modesty during exam
9. Closely monitors Vital Signs, respiratory effort, O2 saturation, and LOC
10. Places child on continuous pulse oximetry if IV pain medication is
administered.
11. Closely monitor’s and documents child’s level of pain relief /response to pain
medication or adjunct interventions every 4 hours or more frequently if
indicated.
12. Provides appropriate adjunctive interventions for comfort and pain relief and
evaluates effectiveness of interventions.
13. Includes parent participation in physical examination, child’s care and
Last revised: 7/14/08 Rural Connection, Inc. Pediatrics Checklist
decision making (age specific)
14. Provide patient/parent education regarding pain management and
document on patient’s flow chart.
Evaluation / Validation Level of Type of
Self - Assessment Comments
Methods Competency Validation
Experienced Verbal Explanation Beginner Orientation
Practice Needed Demonstration Intermediate Annual
Not Experienced Observation Expert Other
Not Applicable Times Completed ____________
(based on scope of Successfully _______
practice) Practice Exercise
Interactive Class
_________________________________ _________________________________
Employee Signature Preceptor Signature
Last revised: 7/14/08 Rural Connection, Inc. Pediatrics Checklist