The ACI, together with the Pain Nurses Australia, pharmacists and expert clinicians in the field of pain management, have standardised eight pain charts for use in NSW hospitals.
The charts have been endorsed by the Clinical Excellence Commission, Medication Safety Expert Advisory Committee and the State Forms Committee for use in NSW public hospitals.
Aims
- Provide a consistent framework and format for prescribing, recording and monitoring adult patients receiving a patient controlled analgesia (PCA), a single dose opioid via the neuraxial route, ketamine infusion, epidural infusion, continuous opioid infusion, or a peripheral nerve infusion.
- Provide 'track and trigger' principles consistent with 'Between the Flags' documentation which recognises the deteriorating adult patient associated with the administration of opioids via the above modalities.
- Improve safety by reducing the incidence of adverse events associated with PCA, ketamine infusions, neuraxial opioid administration, epidural, peripheral nerve and continuous opioid infusions.
Statewide approved pain charts
NSW Health facilities can purchase charts from Finsbury Green.
Sample charts for use in training.
Explanatory notes outline the elements and function of each chart.
Presentations provide clinical staff with an overview of each chart and how to complete each section. The presentations may be tailored to suit individual facilities. Presentations are to be printed in colour to ensure accurate representation of the colour coding for clinical review and rapid response criteria.
Audit tools evaluate the correct use and completion of the pain charts.
Adult
PCA chart (adult): Sample chart (PDF 495.6 KB)
Published: 2021. Next review: 2027.
PCA chart (adult): Explanatory notes (DOC 244.5 KB)
Published: 2021. Next review: 2027.
PCA chart (adult): Presentation (PPT 3.8 MB)
Published: 2021. Next review: 2027.
PCA chart (adult): Audit tool (DOC 170.5 KB)
Published: 2021. Next review: 2027.
PCA chart (adult): Audit spreadsheet (XLS 61.5 KB)
Published: 2021. Next review: 2027.
PCA chart (adult): Audit spreadsheet - example (XLS 67.5 KB)
Published: 2021. Next review: 2027.
Paediatric
PCA or NCA (nurse controlled analgesia) chart (paediatric): Sample chart (PDF 904.1 KB)
Published: 2023. Next review: 2028.
PCA or NCA weight-based chart (paediatric): Sample chart (PDF 868.9 KB)
Published: 2023. Next review: 2028.
PCA or NCA and weight-based charts (paediatric): Explanatory notes (PDF 169.5 KB)
Published: 2024. Next review: 2028.
PCA or NCA chart (paediatric): Presentation (PPT 3.4 MB)
Published: 2024. Next review: 2028.
PCA or NCA weight-based chart (paediatric): Presentation (PPT 9.5 MB)
Published: 2024. Next review: 2028.
PCA or NCA chart (paediatric): Audit tool (DOC 65.3 KB)
Published: 2024. Next review: 2028.
PCA or NCA weight-based chart (paediatric): Audit tool (DOC 65.6 KB)
Published: 2024. Next review: 2028.
PCA or NCA chart (paediatric): Audit spreadsheet (XLS 957.5 KB)
Published: 2024. Next review: 2028.
PCA or NCA chart (paediatric): Sample filled in audit spreadsheet (XLS 73.0 KB)
Published: 2024. Next review: 2028.
Ketamine infusions observation chart (adult): Sample chart (PDF 419.4 KB)
Published: 2021. Next review: 2026.
Ketamine infusion chart: Explanatory notes (DOC 209.5 KB)
Published: 2021. Next review: 2026.
Ketamine infusion : Presentation (PPT 3.5 MB)
Published: 2021. Next review: 2026.
Ketamine infusion chart: Audit tool (DOC 168.5 KB)
Published: 2021. Next review: 2026.
Ketamine infusion chart: Audit spreadsheet (XLS 55.5 KB)
Published: 2021. Next review: 2026.
Ketamine infusion chart: Audit spreadsheet - example (XLS 60.0 KB)
Published: 2021. Next review: 2026.
Neuraxial opioid observation chart (adult): Sample chart (PDF 413.4 KB)
Published: 2021. Next review: 2027.
Neuraxial opioid single dose chart: Explanatory notes (DOC 319.5 KB)
Published: 2021. Next review: 2027.
Neuraxial opioid single dose chart: Presentation (PPT 3.4 MB)
Published: 2021. Next review: 2027.
Neuraxial opioid single dose chart: Audit tool (DOC 168.0 KB)
Published: 2021. Next review: 2027.
Neuraxial opioid single dose chart: Audit spreadsheet (XLS 49.5 KB)
Published: 2021. Next review: 2027.
Neuraxial opioid single dose chart: Audit spreadsheet - example (PDF 254.6 KB)
Published: 2021. Next review: 2027.
Epidural analgesia chart for the non-obstetric environment (adult): Sample chart (PDF 792.2 KB)
Published: 2021. Next review: 2025
Epidural non-obstetric chart (adult): Presentation (PPT 4.1 MB)
Published: 2021. Next review: 2025
Epidural non-obstetric chart (adult): Audit tool (DOC 194.0 KB)
Published: 2021. Next review: 2025.
Epidural non-obstetric chart (adult): Audit spreadsheet (XLS 73.0 KB)
Published: 2021. Next review: 2025.
Epidural non-obstetric chart (adult): Audit spreadsheet - example (PDF 241.5 KB)
Published: 2021. Next review: 2025.
Obstetric epidural analgesia chart: Sample chart (PDF 1.0 MB)
Published: 2023. Next review: 2028.
Obstetric epidural analgesia chart: Presentation (PPT 4.6 MB)
Published: 2023. Next review: 2028.
Obstetric epidural analgesia chart: Audit tool (DOC 58.6 KB)
Published: 2023. Next review: 2028.
NSW obstetric epidural analgesia chart: Audit spreadsheet (XLS 29.5 KB)
Published: 2023. Next review: 2028.
Obstetric epidural analgesia chart: Audit spreadsheet - example (XLS 30.6 KB)
Published: 2023. Next review: 2028.
Continuous opioid infusion chart (adult): Sample chart (PDF 750.9 KB)
Published: 2021. Next review: 2026
Continuous opioid infusion chart (adult): Presentation (PPT 3.9 MB)
Published: 2021. Next review: 2026.
Continuous opioid infusion chart: Audit tool (DOC 168.0 KB)
Published: 2021. Next review: 2026.
Continuous opioid infusion chart: Audit spreadsheet (XLS 60.5 KB)
Published: 2021. Next review: 2026.
Continuous opioid infusion chart: Audit spreadsheet - example (XLS 60.5 KB)
Published: 2021. Next review: 2026.
Peripheral nerve infusion chart (adult): Sample chart (PDF 713.8 KB)
Published: 2017. Next review: 2025.
NSW peripheral nerve infusion chart (adult): Presentation (PPT 3.9 MB)
Published: 2017. Next review: 2025.
NSW peripheral nerve infusion chart (adult): Audit tool (DOC 170.5 KB)
Published: 2017. Next review: 2025.
NSW peripheral nerve infusion chart (adult): Audit spreadsheet (XLS 69.0 KB)
Published: 2017. Next review: 2025.
NSW peripheral nerve infusion chart (adult): Audit spreadsheet – example (XLS 74.5 KB)
Published: 2017. Next review: 2025.