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NSW Standardised Pain Charts (adult and paediatric)

A Statewide initiative of the Agency for Clinical Innovation (ACI) and the Pain Interest Group Nursing Issues (A sub group of the Australian Pain Society)

The ACI together with the Pain Interest Group Nursing Issues and expert clinicians in the field of pain management and pharmacists have standardised eight pain charts for use in NSW hospitals.

These pain charts aim:

  • to 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
  • to 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
  • to 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 Pain Charts Implementation Support Materials

The implementation guide for NSW Pain charts is designed to assist in implementing the standardised pain charts into NSW Public Hospitals.

Explanatory notes have been provided outlining elements and function of each chart.

Slide Presentations have been developed to provide clinical staff with an overview of each chart and how to complete each section. They are provided in PDF and powerpoint. The PowerPoint slide may be tailored to suit individual facilities. Slide presentations are to be printed in colour to ensure accurate representation of the colour coding for Clinical Review and Rapid Response Criteria.

Audit Tools have been designed for facilities to use if they wish to evaluate the correct utilisation of the pain chart they are implementing.

NSW Standardised Pain Charts: Feedback Register Form

PCA Chart

 PCA chart (adult): slide presentation (MS PowerPoint Document - 1.1 MB)

 PCA chart (adult): Summary of revisions 2017 (MS PowerPoint Document - 284.0 KB)

 PCA chart (adult): Explanatory notes (MS Word Document - 243.0 KB)

 PCA chart (adult): Audit tool (MS Word Document - 169.5 KB)

 PCA chart (adult): Audit spreadsheet - Example (MS Excel Document - 67.5 KB)

 PCA chart (adult): Audit spreadsheet (MS Excel Document - 61.5 KB)

 PCA Chart (paediatric): Education presentation (MS PowerPoint Document - 2.7 MB)

 PCA Chart (paediatric): Audit tool (MS Word Document - 136.0 KB)

 PCA Chart (paediatric): Audit spreadsheet (MS Excel Document - 78.0 KB)

Neuraxial Opioid Single Dose Observation Chart (Adult)

Ketamine Infusion Chart (Adult)

 Summary of revisions NSW Ketamine Infusion chart 2017 (MS PowerPoint Document - 220.0 KB)

 Ketamine Infusion chart: Explanatory notes 2017 (MS Word Document - 208.0 KB)

 Ketamine Infusion chart: Audit tool 2017 (MS Word Document - 167.5 KB)

 Ketamine Infusion chart: Audit spreadsheet 2017 (MS Excel Document - 55.5 KB)

Epidural Chart for the non-obstetric environment (Adult)

 Slide presentation NSW epidural chart adult (MS PowerPoint Document - 1.5 MB)

 Audit tool NSW epidural chart adult (MS Word Document - 192.0 KB)

 Audit spreadsheet NSW epidural chart adult (MS Excel Document - 73.0 KB)

Obstetric Epidural Analgesia

 Obstetric epidural analgesia (PDF File - 821.1 KB)

 NSW Obstetric epidural presentation (MS PowerPoint Document - 1.2 MB)

 Explanatory notes NSW obstetric epidural chart (MS Word Document - 1.2 MB)

 Audit tool NSW obstetric epidural chart (MS Word Document - 184.5 KB)

 Audit spreadsheet NSW obstetric epidural chart (MS Excel Document - 76.0 KB)

Continuous Opioid Infusion Chart (Adult)

Peripheral nerve infusion chart (Adult)

Publications

Australian and New Zealand College of anaesthetists and faculty of pain medicine. Acute pain management: scientific evidence. National Health and Medical Research Council.

Overview

Background

At the request of the NSW Department of Health State Forms Committee in 2009, the Pain Interest Group Nursing Issues (a sub group of The Australian Pain Society), undertook the development of standardised pain charts for NSW . The first chart developed was the PCA chart for adult patients.

A Consultative Group of anaesthetists, clinical nurse consultants (specialising in Acute Pain Management) and a pharmacist was established. A large number of PCA charts that were in use at the time throughout the state were collated and reviewed to enable assessment of current practice and to determine key components for inclusion in a standardised chart. Other advisors to this Consultative Group included the NSW Therapeutic Advisory Group ( NSW TAG ) and their members and the Clinical Excellence Commission ( CEC ).

Approval

ACI has overseen the process and eight pain charts have now been endorsed by the CEC, Medication Safety Expert Advisory Committee (MSEAC) and the State Forms Committee for use in NSW public hospitals:

  • PCA (Patient controlled analgesia) (adult) SMR130.025
  • PCA (Patient controlled analgesia) (paediatric) SMR130.026
  • Neuraxial opioid single dose observation chart (adult) SMR130.029
  • Epidural non obstetric for the non-obstetric environment (adult) SMR130.022
  • Obstetic Epidural Analgesia (adult) SMR130.027
  • Continuous Opioid Infusion (adult) SMR130.024
  • Peripheral nerve infusion chart (adult) SMR130.023
  • Ketamine infusion (adult) SMR130.028

Implementation

Implementation support materials provided by the Agency for Clinical Innovation for each pain chart include explanatory notes, education slide presentation and an audit tool. An implementation guide is provided for use with any of the pain charts implemented.

Evaluation and review

In 2014, the charts underwent a process of statewide evaluation and review. The results are presented under Summary of Revisions in each chart category, but overall the charts have had statewide endorsement as improving safety of administration, prescription and monitoring of these modalities.

In 2016 a full review occurred, charts and implementation packages have been updated accordingly.

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