Pain Scale Assessment (QMS-F079) PAIN SCALE ASSESSMENT (QMS-F079) Contact Document Ref: QMS-F079 (Pain Scale Assessment) Version: 1.0 Confidentiality Level: HIGH (Medical Records) CQC Alignment: Effective (Assessing Needs) Service User Full NameService User ID NumberOperating Local Authority- Select -HaringeyIslingtonWaltham ForestBarnetOtherCare Funding & Financial Arrangements- Select -Local Authority Managed (Direct Commissioning)NHS Funded (Continuing Healthcare - CHC)Direct Payments (Personal Budgets)Self-Funded (Full Cost)OtherSECTION 1 - Communication & BaselineIs the service user able to verbally communicate and rate their pain?- Select -Yes (Verbal and cognitively able)No (Requires observational Abbey Pain Scale)Self-Reported Pain Score (1-10)- Select -0 (No Pain)1-3 (Mild Pain - Nagging, annoying, but doesn't interfere with daily living)4-6 (Moderate Pain - Interferes significantly with daily living activities)7-9 (Severe Pain - Disabling, unable to perform daily activities)10 (Worst Possible Pain)SECTION 2 - Observational Assessment (Abbey Pain Scale Indicators)Vocalisation Indicators Whimpering Groaning Crying None observedFacial Expressions Looking tense Frowning Grimacing Looking frightened None observedBody Language & Behavioural Changes Fidgeting Rocking Guarding part of body / Flinching when touched Increased confusion or agitation Refusing to eat None observedSECTION 3 - Pain Location & ManagementLocation and Description of PainDoes the service user have PRN (As Required) pain medication prescribed?- Select -Yes (Ensure PRN protocol is completed on Form 81)NoNon-Pharmacological Pain Relief Methods Repositioning / Posture support Heat packs (WARNING Cold packs Distraction / Conversation Gentle massage (Only if tolerated and no deep tissue injury) None applicableIs the current pain unmanaged, new, or severe (Score 7+)?- Select -Yes (Immediate escalation to GP, 111, or District Nurse required)No (Pain is managed effectively by current interventions)SECTION 4 - Risk Control & Sign-offSpecific Instructions for Care WorkersAssessor NameDate of AssessmentSave Pain Assessment
