Performance Manager
JCAHO Pain Assessment Process Monitoring
  Service Line?
  Unit Name (11R, 12 R, F 3 etc)
  Audit Date
  MRN
  Attending MD
  Auditor Name (First Initial, Last Name, title (RN etc) )
  Initial Pain Score Completed/Documented in pain section of IPA or as 5th Vital Sign on vital sign sheet ? Yes
No
  In review of the last 16 hours was pain reassessed according to policy? (*If receiving PRN meds, pain reassessed within 2 hours of administration as documented on the MAR *If not receiving PRN pain med, pain score documented every 8 hours as 5th vital sign *If receiving epidural, PCA or continuous infusion of pain med, pain score documented per policy) Yes
No
          



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