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Tools: Resources
In this section, you will find samples of useful tools and resources. Some may be in the form of specific instruments, such as a pain intensity assessment scales, while others may be in the form of guidelines or protocols. We will continuously add to this section so if you identify tools or resources of use to your emergency medicine colleagues, please contact us.
| Caregivers | Assessment and other tools that might be useful in working with caregivers or identifying unmet palliative care needs. | ||||||||||||||||||
An assessment tool to identify the level of distress of caregivers of seriously ill patients. Citation: Glajchen J, Kornblith A, Homel P, Fraidin L, Muskop A, Portenoy RK. Development of a Brief Assessment Scale for Caregivers of the Medically Ill. J Pain and Symp Manag. 2005:29(3) |
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| Functional Assessment | Tools to assess patients' ability to perform various tasks as a measure of their degree of illness. | ||||||||||||||||||
A tool to enable professionals and caregivers to assess the decline of patients with Alzheimer’s Disease. Citation: Reisberg, B. Functional Assessment Staging (FAST). Psychopharmacology Bulletin. 1988:24:653-659.
A well-validated and easy-to-use scale for measuring functional status.
A questionnaire to provide information regarding how the patient's back pain affects everyday functioning. Scoring information is provided. |
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| Pain Measurement | Includes a variety of scales and tools for pain assessment. | ||||||||||||||||||
Since pain is a multi-dimensional experience, a more comprehensive understanding of a patient’s pain can be gained with a tool that explores not only the intensity of pain but also the effect of the pain on the patient’s functioning and relationships. The Brief Pain Inventory addresses this need, can be self-administered as well as administered by the practitioner, and takes less than 5 minutes to complete. It is a validated questionnaire and is available in many languages. The Inventory is used to assess pain intensity, location and pain-related functional interference. A longer version also is available that explores other aspects of the person’s pain experience and medication use and effectiveness. Copyright 1991 Charles S. Cleeland, PhD Pain Research Group. Used by permission. For additional information visit the Pain Research Group website. To view the form, follow this link.
A well-validated behavioral pain assessment tool for rating pain in children from 1-7 years old. Citation: McGrath, PJ, Johnson G, Goodman JT, et al. CHEOPS: A behavioral scale for rating postoperative pain in children. In Fields HL et al (editors) Advances in Pain Research and Therapy, (vol. 9). New York, Raven Press.
In the case of very young children it may be necessary to rely on observation. An example of this type of scale is the FLACC– which observes five categories: (F) Face; (L) Legs; (A) Activity; (C) Cry; (C) Consolabiltiy, each of which is scored 0 – 2 resulting in a total score between 0-10. Various factors might affect how children exhibit pain. Observational instruments should be interpreted within the context of the child’s pain experience and with regard to any limits that may exist on his or her ability to display pain behavior. Reference: Merkel, S et al The FLACC: A behavioral scale for scoring postoperative pain in young children 1997 Pediatr Nurse 23(3), p 209-297, © Jannetti Co. Scale reprinted with permission.
Numerical Rating Scales (NRS) are easy to administer and can be administered verbally or with paper and pencil. NRS ratings are increasingly being used in clinical trials since their psychometric properties are similar and patients find them much easier to complete, especially patients who are elderly or have cognitive impairments. Some investigators (see Stahmer, below) have found that using the NRS ensure that more patients will successfully complete their pain assessments. One emergency department study found that failure rates were 15% for the VAS and 0% for the NRS. Reference: Stahmer SW, Shofer FS, Marino A, et al. Do quantitative changes in pain intensity correlate with pain relief and satisfaction. Acad Emerg Med 1998;5:851-7.
A tool to assess pain in patients with advanced dementia, which bases pain assessment on several observational criteria. While this tool has been validated, it has not been validated in diverse populations.
This scale is comprised of illustrations of facial expressions meant to represent various pain states. The patient is asked to pick the expression that best matches the experience he or she is having. Each image is assigned a number that becomes the apin intensity score. Pciture scales demonstrate both criterion and predictive validitiy and are especially useful among populations with limited literacy, including children, or who for other reasons cannot communicate verbally with the medical staff. Reference : Bieri D. Reeve RA. Champion GD. Addicoat L. Ziegler JB. The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties. Pain. 1990;41(2):139-50. Scale reprinted with permission.
Widely used and validated, the authors note that, although developed for young children (age 3 or more), experience has shown that it can be used successfully with juveniles and adults, particularly the elderly. An advantage of the cartoon type scale is that it avoids, gender, age, and racial biases. The coding system translates easily into a 10 point scale. Additional information on using the scale can be found at http://www3.us.elsevierhealth.com/WOW/faces.html Reference: Wong DL, Baker CM Pain in children: comparison of assessment scales, Pediatr. Nurs. 1988 14(1):9017)
These scales consist of adjectives or phrases describing increasing pain intensities. The four-descriptor scale (none, mild, moderate, severe) is widely used in clinical settings because it is easy to use and has demonstrated validity and reliability. It might be difficult to use with patients with limited literacy or cognitive impairment and is less precise than the VAS or NRS. Citation: Todd KH. Pain Assessment Instruments for Use in the Emergency Department. Emerg Med Clin N Am. 23,2005:285-295.
This measurement scale normally consists of a 100 mm line. The right side states something like “worst pain possible” and the left side “no pain.” The patient is asked to mark on the line the point that best describes the pain they are experiencing. The distance from the left of the line to the mark is measured and the pain intensity if reported in millimeters. (range 1 to 100). Unlike the NRS the VAS requires written materials. The VAS has been shown to be a reliable and valid measure of pain intensity in the ED. Reference: Todd KH. Pain Assessment Instruments for Use in the Emergency Department Emerg Med Clin N Am 23 (2005) 285-295. |
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| Substance Abuse | Materials addressing issues related to pain management and substance abuse. | ||||||||||||||||||
Titled Pain Management Without Psychological Dependence: A Guide for Healthcare Providers and prepared by the US Department of Health and Human Services. This fact sheet provides an overview of pain management strategies and guidance in providing pain management without causing psychological dependence. A list of signs that might indicate inappropriate opioid use is included as well as lists of resources and references. |
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| Symptom Assessment | Includes various multiple-symptom assessment tools. | ||||||||||||||||||
A tool to assist in the assessment of nine symptoms in cancer patients providing a clinical profile of symptom severity over time. Guidelines for its use are included. It is provided with the permission of the Capital Health Regional Palliative Care Program.
The Memorial Symptom Assessment Scale (MSAS)-Short Form, is a shortened version of the full MSAS scale. It has been validated and is a quick and easy to use assessment tool for emergency department personnel to assess the extent of symptom burden. It can be given either in writing or verbally. Higher symptom burden will have a negative impact on overall quality of life and might indicate that a palliative care consultation should be considered. Citation: Chang VT; Hwang, SS; Feruerman M; Kasimis BS; Thaler HT. The Memorial Symptom Assessemnt Scale Short Form (MSAS-SF). Cancer 2000:89:1162-71. Used with permission Wiley-Liss, Inc., a subsidiary of John Wiley & Sons, Inc. |
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