Clinical Pathway for Collaborative Care: Acute Pain Management



Via Christi Regional Medical Center-St. Francis Campus

Wichita, KS



Developed by:

Shirley Otto, RN, MSN, CRNI, ADCN

Susan K. Duncan, RN, MS

Larry N. Baker, APR



Clinical Pathway for Collaborative Care

Acute Pain Management


General and Pre-operative/Procedure Data

Patient Name:   Hospital Number:   Date of Birth:  
Date of Admission:   Time of Admission:   Attending Physician:  
Patient Weight:   Patient diagnosis:  
Surgical intervention/procedure:   MD performing procedure:  
Has a comprehensive pain assessment been conducted and documented? o Yes o No  
Has a medical/nursing pain management plan been developed and communicated? o Yes o No  
Does the patient communicate relieved and unrelieved pain? o Yes o No  
Total time in minutes from arrival in nursing unit in acute pain to maximum pain control (0-3 range)?  
Total time in minutes from arriving in pain at Admissions/Emergency Services to maximum pain control (0-3 range)?  
Total time in minutes from initial order to administration of first dose?   First dose of analgesia  
(drug, dose, time)

Therapy Options (see Physician’s Guide for dosing data)


o Opioids o Nonpharmacological interventions

o Local anesthetics

o Epidural

Indications for Epidural Analgesia* -- evaluated daily

o Orthopedic procedures

o Urological procedures

o Gynecological procedures

o Upper Abdominal procedures

o Thoracic procedures

o Trauma victims

o Chronic cancer pain (not relieved by opioids)

Important parameters of assessment with narcotics

o Respiratory rate q hr for 12 hrs then q 4 hrs

o Sedation rate

Important parameters of assessment with local anesthetics

o Vital signs q 4 hrs

o Sensory level & degree of motor block

Other important precautions

o no additional opioids or CNS depressants**

**See Pharmacy listing of CNS depressants

o patient should not ambulate without assistance

* Only Anesthesiologist may insert/prescribe medications for Epidural Analgesia (See Physician Guidelines for Epidural Analgesia)





Indications for PCA* -- evaluated daily

o patient requires parenteral narcotics for at least 24

o post-operative, trauma, burn patient with clear sensorium

o patient suffers from chronic pain

o patient with severe acute pain syndrome

o patient does not tolerate or other routes are unavailable

*See Physician Guidelines for dosage, rate, etc.



Discharge criteria met:

o Patient’s pain reduced or alleviated

o Patient’s personal preferences are met

o Patient demonstrates skills required to manage pain

o Patient states resources available to assist with pain concerns





See reverse side for patient, physician, and nurse interview questions.