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Q: Questions have come up as to ideas on pain management in the labor and delivery area, also NICU and how about the nursery for circumcisions? Any ideas of pain scales to be used in these areas? We are in a quandary-nothing seems to really fit.

A: There are many articles on nonverbal scales for infants in the literature. Also, look in the peds section of the Resource Manual -- St Judes has its FLACC scale and Albany had a NIPS scale to assess pain in infants. There is a circumcision guideline.

Q: In a recent publication "Inside the Joint Commission" it states that there is an "objective scale for unconscious patients with six total pain scales." Is anyone aware of this and does anyone use something specific at this point?

A: We use a FLACC scale for our patients who are unable to respond. I believe it was developed by people at University of Michigan, and by observing the patient's Face, Legs, Activity, Cry and Consolability, there is a scale that awards points to each category, coming up with a score that is equal to a pain scale of 0-10. Hospice uses this scale frequently, and thus far it has worked well. NOTE: The FLACC SCALE is located in the Building an Institutional Commitment to Pain Management Manual (also on CD ROM) provided in your project box.

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