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Forms/Sedation-Scoring/FRM-SED-002-NPASS-Scale.md

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+# Neonatal Pain, Agitation & Sedation Scale (N-PASS)
+
+| Form ID | FRM-SED-002 | Revision | 1.0 |
+|---------|-------------|----------|-----|
+
+---
+
+## Patient Information
+
+| Field | Entry |
+|-------|-------|
+| Patient Name | |
+| MRN | |
+| Gestational Age | |
+| Assessment Date | |
+| Assessment Time | |
+| Assessed By | |
+
+## Assessment Instructions
+
+- Assess infant behavior over 1-2 minutes
+- Score sedation criteria first (if sedated), then pain/agitation criteria
+- Note: Premature infants may have muted responses
+
+## Sedation/Pain Assessment
+
+### 1. Crying/Irritability
+
+**Sedation**
+- [ ] -2: No cry with painful stimuli
+- [ ] -1: Moans/cries minimally to painful stimuli
+- [ ] 0: Appropriate crying, not irritable
+
+**Pain/Agitation**
+- [ ] +1: Irritable at intervals, consolable
+- [ ] +2: High-pitched or silent continuous cry, inconsolable
+
+### 2. Behavior/State
+
+**Sedation**
+- [ ] -2: No arousal to any stimuli, no spontaneous movement
+- [ ] -1: Arouses minimally to stimuli, little spontaneous movement
+- [ ] 0: Appropriate for gestational age
+
+**Pain/Agitation**
+- [ ] +1: Restless, squirming, awakens frequently
+- [ ] +2: Arching, kicking, constantly awake or minimal sleep
+
+### 3. Facial Expression
+
+**Sedation**
+- [ ] -2: Mouth lax, no expression
+- [ ] -1: Minimal expression with stimuli
+- [ ] 0: Relaxed, appropriate facial expression
+
+**Pain/Agitation**
+- [ ] +1: Any pain expression intermittent
+- [ ] +2: Any pain expression continual
+
+### 4. Extremities/Tone
+
+**Sedation**
+- [ ] -2: No grasp reflex, flaccid tone
+- [ ] -1: Weak grasp reflex, decreased tone
+- [ ] 0: Relaxed hands/feet, normal tone
+
+**Pain/Agitation**
+- [ ] +1: Intermittent clenched toes/fisted hands, increased tone
+- [ ] +2: Continual clenched toes/fisted hands, body tense
+
+### 5. Vital Signs (HR, RR, BP, SaO2)
+
+**Baseline Values:**
+- HR: ______ bpm
+- RR: ______ breaths/min
+- BP: ______ mmHg
+- SaO2: ______ %
+
+**Sedation**
+- [ ] -2: No variability with stimuli, hypoventilation or apnea
+- [ ] -1: Less than baseline variability, slow or pause in respirations
+- [ ] 0: Within baseline, no out-of-sync breathing on vent
+
+**Pain/Agitation**
+- [ ] +1: SaO2 76-85% with stimulation, quick return to baseline
+- [ ] +2: SaO2 ≤75% with stimulation, slow return to baseline, out-of-sync with vent
+
+## Total Score
+
+**Total N-PASS Score:** ______
+
+(Range: -10 to +10)
+
+## Score Interpretation
+
+- **-10 to -5**: Deep sedation
+- **-4 to -2**: Light-moderate sedation
+- **-1 to +1**: Normal sedation/pain management
+- **+2 to +5**: Mild to moderate pain/agitation
+- **+6 to +10**: Severe pain/agitation
+
+## Clinical Action
+
+### Current Sedation/Analgesia
+| Medication | Dose | Route | Frequency |
+|------------|------|-------|-----------|
+| | | | |
+| | | | |
+
+### Action Taken Based on Score
+- [ ] No change needed
+- [ ] Increase sedation/analgesia
+- [ ] Decrease sedation/analgesia
+- [ ] Notify physician
+- [ ] Non-pharmacological comfort measures
+- [ ] Other: ____________
+
+### Non-Pharmacological Interventions Used
+- [ ] Swaddling
+- [ ] Pacifier
+- [ ] Positioning
+- [ ] Reduced stimulation
+- [ ] Skin-to-skin care
+- [ ] Other: ____________
+
+### Comments
+
+
+
+## Signature
+
+| Role | Name | Signature | Date/Time |
+|------|------|-----------|-----------|
+| RN | | | |
+
+---
+
+*Form FRM-SED-002 Rev 1.0*
+
+**Reference:** Hummel P, Puchalski M, Creech SD, Weiss MG. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol. 2008.