SOUTHERN WEST MIDLANDS

Neonatal Pain Assessment Tool (PAT) NEWBORN NETWORK

NHS
Instructions for assessment

• Nurse stands where the baby’s body and face can be seen clearly Name
• Observe for two minutes without interruption

Minimum frequency of assessment:

Date of Birth
• Intensive care: Within 1 hour of admission. Hourly with observations Hospital No.
• High dependency: Within 1 hour of admission. 6-8 hrly (before cares) or if signs of
distress /discomfort
• Special care: Within 1 hour of admission. If baby shows signs of distress/discomfort NHS No.
Not associated with need for routine care giving
• Post-operatively: Hourly for first 8 hours. 4 hourly until 48 hours post-op. Consultant
The score generated will dictate the frequency of assessment.

Repeat assessment 30minutes after any intervention or action is taken.

Do not score if the baby is paralysed as behavioural parameters cannot be assessed. Document date, time, doses of paralysing agents,
sedatives and analgesics and sign.

Recommence PAT when paralysis discontinued.

Clinical management
Score 0-4 continue current management or consider weaning analgesia
Score 5-8 institute comfort measures
Score 9 or more requires comfort measures and review analgesia
Assign score for each parameter that best describes the infant. Not every descriptor in each box needs to be present. With each assessment actions
and interventions must be documented and the PAT signed.

0 1 2
Behavioural states Relaxed Agitated Squirming
Settled Easily woken No deep sleep pattern
Asleep Startles on waking Gaze aversion/ shut down
Quiet alert Restless
Drowsy
Posture/tone Relaxed Extended Flexed/extended or tense
Finger splay Clenched fists
Stiff trunk Rigid trunk
Limbs drawn out Head and shoulders resist positioning
Shoulders raised off mattress Term babies- limbs down to midline
Cry None or cries briefly but Crying and difficult to console Whimpering, whining or loud cry which does not cease
consoles easily when consoled
Silent cry for ventilated infants
Facial expression Relaxed Frown with slight naso-labial Grimace with deep naso-labial furrow
furrow Brow bulge
Eyes clenched shut
Colour (If no cardio-vascular Centrally pink Pale, dusky
compromise) Well perfused Flushed
Mottled
Respirations Normal for baby Tachypnoea at rest (>60) Apnoea at rest or with handling
40-60bpm Ventilated via ETT

Heart rate Normal for baby Tachycardia at rest Bradycardias with/ without handling
Fixed heart rate
Oxygen saturations Normal for baby Occasional desaturations Frequent desats

Blood Pressure Normal Hypertensive

Outsider perception No pain observed Infant appears to be in pain

Codes Comfort measures Actions taken

R Gently repositioning the baby to B Bolus of analgesia
Analgesia Sedation Paralysis promote comfort I Increased infusion of
DM Diamorphine CH Chloral Hydrate A Atracurium S Swaddling (blanket/nest) to provide analgesia
F Fentanyl Mi Midazolam P Pancuronium containment and support to limbs D Decreased infusion of
C Comfort/containment holding analgesia/
P Paracetamol V Vecuronium
E Decreasing environmental stimuli sedation/paralysis
O Oral Morphine R Rocuronium
(reducing light, noise and activity Nil No action taken
CP Codeine phosphate S Suxamethonium around the baby) PB Pre-procedure bolus
M Morphine V Soothing voice of analgesia
N Nappy change Pre Pre-procedure score
P Non-nutritive sucking (pacifier/gloved Post Post-procedure score
finger)
Sedation will mask behavioural signs of pain
K Kangaroo care
Br Breast feed
Adapted from PAT – Pain Assessment Tool by Hodgkinson, Baer, Thorn and Van Blaricum (The Australian Journal of Advanced Nursing, 1994.)
 SOUTHERN WEST MIDLANDS NEWBORN NETWORK NHS
Neonatal Pain Assessment Tool (adapted from PAT)
Date
Time
Current situation (drug
infusion, cares etc

Opioid infusion/bolus
micrograms per kilogram per hour or
bolus
Sedation infusion/bolus
micrograms per kilogram per hour or
bolus
Paralysis infusion/bo lus
(if paralysed only document
medication, don't complete PAT)
Gestational age
( weeks )
Behavioural state
Relaxed 0
Agitated 2
Colour
(if no cardio-vascular compromise)
Centrally pink 0
Pale/dusky/mottled 2
Posture/tone
Relaxed 0
Extended 1
Flexed/ or tense 2
Cry
None/consolable 0
Consoles with difficulty 1
Yes/silent cry 2
Facial expression
Normal/none 0
Minimal 1
Grimace 2
Respirations
Normal 0
Tachypnoea/ventilated 1
Apnoea 2
Heart rate
Normal 0
Tachycardia at rest 1
Fixed/ bradycardia 2
Oxygen saturations
Normal 0
Occasional desats 1
Frequent desats 2
Blood p ressure
Normal 0
Hypertensive 2
Outsider perception
No 0
Yes 2

Total score /20

Comfort measure

Action taken

Initials