Search for the Evidence: A computerized literature search was performed using the words pediatric pain, pain scales, pain assessment, and pain documentation. The search yielded thirteen studies; four were for the purpose of validation of the FLACC scale in various populations.

Critical Appraisal of the Evidence: Critique of the evidence was done by the principle investigator, the Research Nurse Coordinator and a staff colleague. The evidence was evaluated for validity and reliability of the tool in the populations of interest, as well as evidence of improved pain assessment, documentation and management.

Synthesis and Integration of the Evidence: The outcome variables included the improvement of pain documentation, pain management, and staff and patient satisfaction. The study findings indicated that pain management did not consistently improve following staff education but did improve following implementation of an objective pain assessment and documentation tool. Studies also found improved documentation was related to improved pain management.

Evaluation of Outcomes: Following nurse education and implementation of the FLACC scale for assessment and documentation of pain in children unable to self-report, data collection will be completed using a revision of the current NDNQI chart audit form to analyze for change in nurse documentation.

Implications for Nursing Care: Replacement of the three current pediatric pain scales for children unable to self-report with one scale that is more appropriate for that population will help streamline and standardize pain assessment and documentation. Improved documentation will assist in improving pediatric pain management.

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