Sign Up
Login
Try for Free
Login
The Wong-Baker FACES Pain Rating Scale is a self-report pain intensity tool on which a patient aged three or older chooses the face that matches their pain, recorded on a 0 to 10 metric. Pediatric, emergency, perioperative, and medical-surgical nurses use it when a patient cannot use a numeric scale; it is never rated by an observer. This page covers how to document a FACES rating, with a fictional sample.
The patient rates; the nurse, physician, dentist, or other clinician who administered the scale records it. Registered nurses at the bedside, in emergency departments, procedure areas, and clinics do most of the charting; no publisher qualification level or training requirement applies, and organizations obtain their own permission or license from the Foundation for the artwork they display
Oncoming nurses and the treating physician or advanced practice provider, pharmacists reviewing analgesic response, anesthesia and procedural sedation teams, discharge and after-visit summary writers, quality staff auditing pain reassessment, accreditation surveyors, and expert reviewers in pain management claims
3 to 8 chart lines per assessment (scale and reason chosen, self-selected rating with time, location, onset, and character, intervention, timed reassessment on the same scale, function against the goal) · about 1 to 2 minutes to administer and record
Patient self-report pain intensity scale (six faces the patient chooses from, recorded on a 0 to 10 metric in steps of two; validated for ages three and older; not an observational or clinician-rated tool)
Emergency department and admission pain screening, pre-procedure and post-procedure pain assessment, post-operative and medical-surgical reassessment after analgesia, pediatric and adult primary and urgent care visits, dental and outpatient procedures, and any patient who cannot use a numeric scale but can understand the task and choose
Wong and Baker (Pediatric Nursing, 1988; created 1983); artwork copyrighted and the name a registered trademark of the Wong-Baker FACES Foundation, licensed by use category; required by no law, accreditor, or payer in the United States, Canada, or Australia; described here for documentation, no artwork or instructions reproduced
The Wong-Baker FACES Pain Rating Scale is a self-report tool for pain intensity: the patient looks at six faces and chooses the one that matches how much pain they have, and the clinician records the number that belongs to the chosen face on a 0 to 10 metric in steps of two. Donna Wong, a nursing author, and Connie Baker, a child life specialist, created it in 1983 at Hillcrest Medical Center in Tulsa to help hospitalized children communicate pain, collected the validation data at Hillcrest, St. Francis Hospital, and the University of California Davis Medical Center, and published the comparison study in Pediatric Nursing in 1988 (volume 14, pages 9 to 17); the scale first appeared in the textbook Whaley and Wong's Nursing Care of Infants and Children. The original version was scored 0 to 5, and the Foundation now uses the 0 to 10 metric so that the values sit on the same range as the numeric rating scale, although, as the sections below explain, they are not the same values. The Foundation states that the scale is used around the world with people ages three and older, not only children, that it is a self-assessment tool for physical pain only, that it may not be modified or colored, and that it is not to be used by a third person, whether a parent, a caregiver, or a health professional, to assess the patient's pain. The artwork and the scripted instructions are the Foundation's copyrighted material and are not reproduced or paraphrased here.
The load-bearing fact for documentation is that the scale is self-report or it is nothing. A chart entry that reads as if the nurse read the patient's face against the pictures records something the Foundation says the tool must never be used for, and it records a different construct from the one the validation studies measured. Three consequences follow. First, the patient must be able to understand the task and choose, which is why the Foundation excludes unresponsive patients and why the note has to say that self-report was obtained. Second, the rating belongs to the patient even when the nurse disagrees with it: the behavioral observation goes in the record beside the rating, never in place of it. Third, a FACES value and a numeric rating scale value are not interchangeable even though both run 0 to 10, so the scale name travels with every number and the two are never plotted as one trend. The Faces Pain Scale-Revised, owned by the International Association for the Study of Pain, is a different faces scale with different anchors and its own rights terms, and the observational tools used when a patient cannot self-report (the FLACC for young children, the CPOT and the PAINAD for adults) rate behavior rather than report; the sedation and arousal assessment that decides whether an intensive care patient can self-report at all belongs to the RASS page, the delirium screen that follows it to the CAM-ICU page, and the responsiveness assessment in trauma and neurologic care to the Glasgow Coma Scale page.
Pediatric and emergency nurses chart it at triage and after every intervention for children who can choose a face but cannot yet use numbers reliably, and for older children who prefer it. Post-anesthesia, day surgery, and medical-surgical nurses use it after procedures and operations for adults who cannot use a numeric scale because of language, literacy, hearing, or early cognitive change, and dental and outpatient procedure staff use it before and after local anesthesia and minor procedures. Primary and urgent care clinicians record it at acute visits for injuries, otitis, sore throat, and abdominal pain. Anesthesia and procedural sedation teams read the entries to judge analgesic response; pharmacists read them when reviewing opioid orders; discharge writers carry the last rating and the scale name into the after-visit summary and the discharge summary; quality staff audit whether every intervention was followed by a timed reassessment; and surveyors read the same entries against the organization's own pain assessment criteria. The FACES page owns one job: how to record a patient-selected rating so that the scale, the self-report, the context, the response, and the reason for the tool choice are all visible. Neighbors take over at the edges: when a patient cannot self-report, the nurse switches to an observational tool and documents why, the intensive care gate for that decision is the RASS, and the nursing admission bundle that often sits on the same flowsheet includes the Braden Scale and the Morse Fall Scale; the pain regimen and the scale in use travel in the transfer of care summary at handoff.
No regulator, accreditor, or payer prescribes a FACES note format or requires the scale by name; what exists is the Foundation's use conditions (self-report, physical pain, ages three and older, no observer rating), the Joint Commission's requirement that an organization define its own criteria to screen, assess, and reassess pain consistent with the patient's age, condition, and ability to understand, and unit policies that set reassessment timing. What survives review is an entry that names the scale and the reason it was chosen, states that the patient selected the rating, describes the pain in the patient's words, sets a function goal, records the intervention with its time, dose, and route, reassesses on the same scale at a time that fits the route, keeps observations and proxy impressions separate from the rating, and never mixes FACES values with numeric-scale values in one trend. Each element below carries the pitfall that most often undermines it.
Scale selection and the reason for it. Open with the tool and why: "Wong-Baker FACES used; patient is six, understood the task, and chose readily; could not explain the numeric scale," or, for an adult, "FACES used because the patient reads little English and declined the number scale; interpreter present." The Foundation validates the scale for ages three and older, but the evidence for self-report in three- and four-year-olds is weak, the verbal numeric scale is supported from about age six, and cognitively impaired older adults often manage a faces scale better than numbers, so the reason is a clinical judgment worth one clause. If the patient could not understand or respond, record that self-report was not obtainable and name the observational tool used instead. Pitfall: A rating with no scale named, or a scale chosen by habit (FACES for every child, numbers for every adult) with nothing in the note to show the patient could actually use it.
Self-report, stated as such. Write the rating as the patient's choice with the scale beside it: "Wong-Baker FACES 8, patient selected at 16:25." The word selected, or pointed to, or chose, is what tells the next reader that the tool was used as designed. Never rate the patient yourself by comparing their face to the pictures; the Foundation states the scale is not to be used by a third person, parents or clinicians included. If a parent or caregiver offers an impression, record it as a parent impression in its own clause, never as the patient's rating, because parent and child ratings diverge and a proxy number masquerading as self-report cannot be trusted later. Pitfall: "Appears to be a 6 on FACES," or a parent's guess entered in the pain score field as if the child had chosen it.
Location, onset, character, and what changes it. A rating is one dimension of pain; the assessment is the rest. Record where it hurts (with laterality), when it started and what started it, the patient's own descriptive words, what makes it worse and better, and the pattern since the last assessment. For a young child, take the words the child uses and add what the parent reports about onset and behavior at home, labeled as parent history. The Joint Commission's hospital standard asks organizations to define criteria for assessment consistent with age, condition, and ability to understand, and every published criteria set includes location and character; a bare number satisfies none of them. Pitfall: "Pain 8/10 FACES" with no location, onset, or character, so the entry cannot be compared with the next one or defended as an assessment.
Comfort and function goal. Set a goal in terms of what the patient needs to be able to do and write it down: hold the arm still for splinting and imaging, take a deep breath and cough after surgery, sleep through the night, walk to the bathroom, tolerate the dental impression. The Joint Commission's reassessment element asks for progress toward pain management goals including functional ability and gives deep breathing, turning in bed, and walking as its examples; the AHRQ patient safety chapter calls this the comfort-function goal. Agree the goal with the patient or family where possible and state who agreed it. Pitfall: "Goal: pain less than 4" as the only target, with nothing about what the patient should be able to do and no record that anyone agreed it.
Intervention with time, dose, and route. Record what was done and when: the analgesic with dose, route, and time; the nonpharmacologic measures (immobilization, ice, elevation, positioning, distraction, a parent at the bedside); and, when nothing was given, the reason (patient declined, rating below the agreed threshold, awaiting the provider). The intervention is what the reassessment will be judged against, so the times must be real and the dose must match the medication administration record. Pitfall: "Medicated per order" with no drug, dose, route, or time, or an intervention charted at a time that conflicts with the administration record.
Reassessment, timed to the route, on the same scale. Reassess at a time that fits the drug's onset and your unit policy, and say so: the AHRQ patient safety chapter gives 15 to 30 minutes after an intravenous opioid and 45 to 60 minutes after an oral opioid or nonopioid as the working intervals, and no regulator sets one. Use the same scale, have the patient choose again, and record the new value with the time, the function result against the goal, side effects, and, when an opioid was given, a sedation score such as the POSS, because sedation precedes respiratory depression. A sleeping patient is not reassessed with the scale: describe the sleep and the breathing, do not enter a score, and reassess when the patient wakes. Pitfall: "Reassessed, pain improved" with no time, no scale, and no value, or a sleeping child entered as 0.
Trend integrity, tool changes, and handoff. Keep FACES values in a FACES trend. A 6 chosen on the faces and a 6 spoken on the numeric scale are different measurements, and averaging or plotting them together produces a line that means nothing; when the tool changes because the patient's ability changed, start a new labeled trend and write the reason. When self-report is no longer obtainable, switch to an observational tool, name it, and record why, following the hierarchy in the ASPMN position statement (attempt self-report, consider causes of pain, observe behavior, obtain proxy report, consider an analgesic trial). Carry the scale name into the handoff, the transfer summary, and the discharge plan so that the next clinician keeps the same tool, and tell informatics if the electronic record maps both scales into one pain score field. Pitfall: A pain graph that mixes FACES and numeric values, or a handoff that says pain 4 with no scale, so the next shift switches tools and the trend breaks.
WONG-BAKER FACES PAIN DOCUMENTATION BLOCK (patient self-report only) Date / time: [ ] Setting: [ ] Clinician: [ ] Encounter: [ED / admission / procedure / post-operative / medical-surgical / primary or urgent care / dental] Ability to self-report: [confirmed: understood the task and chose a face / not obtainable: observational tool used instead (name it) and the reason] Scale chosen and why: [Wong-Baker FACES because ... / numeric scale not usable because ... / patient preference] Language / interpreter: [ ] Prior tool in this record: [same scale continued / tool changed, new trend, reason] Rating: Wong-Baker FACES [ ] (0 to 10 metric), patient selected at [time] Parent or caregiver impression (if recorded, labeled as such): [ ] Location and laterality: [ ] Onset and cause: [ ] Duration / pattern: [ ] Character (patient's words): [ ] Worse with: [ ] Better with: [ ] Comfort and function goal: [what the patient needs to be able to do; agreed with] Intervention: [drug, dose, route, time / nonpharmacologic measures / none, reason] Reassessment at [time, chosen to the route per unit policy]: Wong-Baker FACES [ ], patient selected Goal: [met / not met] Side effects: [ ] Sedation score if opioid given: [ ] Observed behavior (recorded beside the rating, never in place of it): [ ] Sleeping at reassessment: [describe sleep and breathing; no score; reassess when awake] Communication: [provider notified, time / handoff / discharge plan names the scale] Clinician signature / credentials: Date:
Free to use and share, no signup. The PDF includes a one-page cheat sheet with element-by-element pitfalls and a pre-sign checklist; the DOCX is the blank documentation block, ready to adapt. Neither reproduces the faces artwork or the Foundation's instructions.
Scenario: a community hospital pediatric emergency department, where a six-year-old with a forearm injury cannot use the numeric scale but chooses a face readily; the nurse records why the Wong-Baker FACES scale was chosen, the patient-selected rating with the time, the pain description in the child's words, a function goal, an oral analgesic with its dose and time, a reassessment timed to the route on the same scale, the observed behavior and the parent's impression kept separate from the rating, and a discharge plan that names the scale. All details are fictional.
Patient: T.M., 6 · Setting: Pediatric emergency department, community hospital · Clinician: K. Alvarez, RN · Note date: 09/12/2026
Scale selection and self-report: T.M., age 6, brought by his mother after a fall from a scooter at about 15:40 on 09/12/2026, arrived 16:10, triaged 16:20. Asked to rate his pain on the department's 0 to 10 numeric scale, he could not say what a number would mean. Offered the Wong-Baker FACES scale, he understood the task on the first explanation and pointed to a face without prompting, so FACES was chosen over the numeric scale; an observational tool (FLACC) was not used because self-report was obtainable. English speaking, no interpreter needed. Rating: Wong-Baker FACES 8, patient selected at 16:25. His mother's comment that the pain is worse than he is showing is recorded here as a parent impression, not as the rating.
Pain assessment: Location: right forearm, dorsal aspect, about two finger widths above the wrist, which he points to with his left hand; no other painful area reported and none found on examination. Onset: at the fall, about 45 minutes before triage, landing on the outstretched right hand. Character in his words: it stings and it hurts when I wiggle it. Worse with movement and with touch over the area; better when he holds the arm against his chest. No prior injury to the arm, no analgesic given at home today, no known allergies, weight 21.0 kg on the department scale. Mother's history, labeled as such: he was upset at the scene, has not used the hand since, and ate a snack in the car.
Goal and intervention: Comfort and function goal agreed with T.M. and his mother at 16:30: able to hold the arm still for imaging and splinting and to tell us when it hurts. Ibuprofen 210 mg (10 mg per kg) oral suspension given at 16:35 under the department's pediatric analgesia protocol order, documented on the medication administration record at the same time. Arm placed in a padded temporary splint and elevated on a pillow at 16:38; wrapped ice pack applied over the splint; mother at the bedside with a tablet for distraction. Emergency physician notified of the 16:25 rating and the injury at 16:28. Radiographs of the right forearm and wrist obtained at 16:50; he held still for imaging.
Reassessment: At 17:25, 50 minutes after the oral dose (department policy sets 45 to 60 minutes for oral analgesics; the interval is policy, not a regulation), asked to choose again on the same scale: Wong-Baker FACES 4, patient selected at 17:25. Observed behavior, recorded beside the rating and not in place of it: watching a video, arm resting quietly in the splint, no guarding when the ice pack was repositioned, answering questions readily. Goal met so far: held still for imaging without distress. No nausea, no vomiting, no rash. No opioid was given, so no sedation score is required. Mother's observation that he seems much better is recorded as a parent observation.
Result, plan, and communication: Radiographs read by the emergency physician at 17:35: buckle fracture of the distal right radius, no displacement, no growth plate involvement. Short arm splint applied by the orthopedic technician at 17:40; T.M. held still and reported no increase in pain during application. Pre-discharge rating on the same scale: Wong-Baker FACES 2, patient selected at 18:05. Discharged with his mother at 18:10. Plan in the after-visit summary: ibuprofen 210 mg by mouth every 6 to 8 hours with food as needed for up to 3 days, splint care and elevation, no sports or scooter until cleared, return precautions for numbness, swelling, color change, or pain that wakes him or is not relieved by the dose; orthopedic clinic appointment 09/17/2026. The summary names the Wong-Baker FACES scale as the tool used today so that the clinic continues it. All three ratings are charted in the FACES trend only; no numeric-scale value was entered. Findings and the two reassessments reviewed with the emergency physician at 17:38 and reported at the 19:00 handoff.
This sample is fictional and for educational purposes. It does not describe a real patient or record; the ratings, dates, and details are invented to show documentation structure and are not clinical guidance. No scale artwork or instructions are reproduced.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsUnited States: no LAW names the Wong-Baker FACES scale, and the rules that do exist judge whether an assessment led to a response. Under LAW, the Medicare Conditions of Participation for hospitals require the nursing staff to develop and keep current a nursing care plan for each patient that reflects the patient's goals and needs (42 CFR 482.23(b)(4)) and require every medical record entry to be legible, complete, dated, timed, and authenticated, with the record describing the patient's progress and response to medications and services (42 CFR 482.24(c)); neither names a pain tool. California's Health and Safety Code section 1254.7 (LAW, for California-licensed facilities) makes pain an item that must be assessed as a condition of licensure, performed in a consistent manner that is appropriate to the patient and noted in the patient's chart; AB 1048, effective January 1, 2018, removed the earlier requirement that pain be assessed at the same time as vital signs. The Joint Commission's hospital standard PC.01.02.07 (CONVENTION with accreditation force, effective January 1, 2018, and for ambulatory care, critical access hospitals, and office-based surgery from January 1, 2019) requires the organization to define criteria to screen, assess, and reassess pain that are consistent with the patient's age, condition, and ability to understand (EP 1), to screen for pain at emergency department visits and at admission (EP 2), and to reassess and respond to pain through evaluation and documentation of the response to interventions, progress toward pain management goals including functional ability, side effects, and risk factors for adverse events (EP 7); its rationale states that using numerical pain scales alone to monitor pain is inadequate and that pediatric patients and intensive care patients who cannot self-report require alternative tools. The Joint Commission names no instrument and sets no reassessment interval, and its own clarifications matter for the habits this page corrects: in April 2016 it stated that it does not endorse pain as a vital sign, that the standards never required treating pain to a number or to zero, and that the requirement to assess pain in all patients was removed from hospital accreditation in 2009; a 2017 JAMA account by the Joint Commission's David Baker records that the 2001 implementation example calling pain a fifth vital sign had been deleted from the manual by 2004. Under PAYER POLICY, CMS removed the pain management questions from the HCAHPS survey for discharges from October 1, 2019, so no patient-experience score now turns on pain ratings, and no Medicare payment rule names a pain scale. The rest is CONVENTION: the 15 to 30 minute reassessment after an intravenous opioid and 45 to 60 minutes after an oral analgesic come from drug onset and the AHRQ patient safety chapter, not from any regulation; "medicate above 4" appears in no standard; and Mularski and colleagues found across 600 visits at a Veterans Affairs medical center that measuring pain as the fifth vital sign did not by itself improve the quality of pain management, which is the evidence that a documented rating matters only when it is followed by a documented response. In survey and claims review (CONVENTION), the retrospective question is whether a rating led to an intervention and a timed reassessment on the same scale; no published dataset counts how often pain reassessment gaps appear in nursing negligence claims, and this page does not claim one.
Canada and Australia require assessment and name no tool, and the age and comparability evidence explains why the reason for the tool choice belongs in the note. In Canada, no federal or provincial LAW names the scale. CAN/HSO 13200:2023, Pediatric Pain Management, the national standard co-developed by the Health Standards Organization and Solutions for Kids in Pain (CONVENTION with standards force), applies to hospital inpatient, procedural, and outpatient care from birth to 19 years, sets out 34 criteria, calls for consistent documentation of pain assessment results and the care plan in the child's health record and for support that maximizes the child's ability to self-report, and states that it does not prescribe a particular approach; Accreditation Canada's Qmentum standards address pain assessment, and the wording your organization is surveyed against should be confirmed in its own standards set; the Registered Nurses' Association of Ontario's best practice guideline Pain: Prevention, Assessment, and Management reached its fourth edition in February 2025. In Australia, no LAW names the scale; the Australian Commission on Safety and Quality in Health Care's Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard (2022) carries a quality statement on acute pain assessment among its nine statements, the NSQHS Comprehensive Care Standard requires screening and comprehensive assessment processes without naming a pain tool (CONVENTION with accreditation force), and the ANZCA and Faculty of Pain Medicine text Acute Pain Management: Scientific Evidence, fifth edition (2020), is the evidence reference. On the evidence: the Foundation states the scale is for ages three and older, and a 2017 systematic review (von Baeyer and colleagues) found no evidence that three-year-olds and only weak evidence that four-year-olds can use published self-report tools validly, with IASP commentary placing strong evidence at five and older; Tsze and colleagues (2018) found the verbal numeric scale strong for ages 6 to 17 and not strong at 4 and 5, and von Baeyer and colleagues (2009) tentatively supported the numeric scale from age 8; Birnie and colleagues' 2019 systematic review strongly recommended the NRS-11, the Faces Pain Scale-Revised, and the Coloured Analogue Scale for acute pain, rated the Wong-Baker scale well established but gave it only a weak recommendation, and recommended no measure for children under six; Tomlinson and colleagues (2010) reviewed 14 faces scales, found four adequately supported, found that children preferred the Wong-Baker scale when given a choice, and named the confounding of pain intensity with affect as its disadvantage, the effect Chambers and colleagues demonstrated in 1998, 1999, and 2005, where scales with emotion-laden end anchors produced higher ratings than scales with neutral anchors; Garra and colleagues (2010) found agreement with a visual analogue scale of rho 0.90 in 120 emergency patients with a median age of 13, which supports validity at the group level and says nothing about whether an individual's FACES 6 equals a numeric 6; and Ware and colleagues (2006) found that among 68 older minority adults the cognitively intact preferred the numeric scale while cognitively impaired, African American, and Hispanic participants preferred the Faces Pain Scale-Revised. Two version facts belong in the record: the original scale was scored 0 to 5 and current use is on the 0 to 10 metric, so an old form and a new one do not read the same; and the Foundation permits no modification and no added color, so a locally altered version is not the validated scale and should not be charted under its name.
Wong-Baker FACES is a registered trademark of the Wong-Baker FACES Foundation (US Reg. No. 4221357, registered October 9, 2012 in International Class 010 for pain rating scales and charts for diagnostic use in medical examinations, renewed March 3, 2022, with the word FACES disclaimed apart from the mark), and the faces artwork is copyrighted: the Foundation's required caption reads "Copyright 1983, Wong-Baker FACES Foundation, www.WongBakerFACES.org. Used with permission." with an Elsevier credit added in publications because the scale was originally published in Whaley and Wong's Nursing Care of Infants and Children. The Foundation, established in 2009 to protect the integrity of the scale, licenses it by use category (personal, healthcare organization, healthcare provider, healthcare educator, healthcare student, school nurse, commercial, publishing, research, and paramedic); its pages state that licensing is not required for every situation, that personal permission is granted through a web form, that use in facilities, commercial products, or publications will likely need a licensing agreement and fee, with organizations asked to request a quote, that no modifications may be made and no colors added, and that the scale is a self-assessment tool for physical pain only, never for unresponsive patients and never for a third party to rate someone else's pain. No blanket free clinical-use or electronic-record grant is published on those pages as of September 2026, so a facility form, an EHR build, an app, or a public web page that displays the faces should rest on the Foundation's written permission or license; this page displays none of the artwork and quotes none of the instructions. BastionGPT is not affiliated with, or endorsed by, the authors or the rights holder. This page reproduces no test items, stimuli, norms, or scoring materials.
The numbers behind these errors are specific. In the systematic review of 14 faces scales, children preferred the Wong-Baker scale when given a choice, and the same review named the confounding of pain intensity with affect as its disadvantage (Tomlinson and colleagues, 2010); in Chambers and Craig's 1998 experiment, children using a scale with an emotion-laden no-pain anchor gave significantly higher scores to no-pain vignettes than children using a neutral-anchored scale (Pain, 1998), and the same effect held for children's and parents' ratings after minor surgery (Chambers and colleagues, 2005). The 2019 quality assessment of pediatric self-report measures strongly recommended the NRS-11, the Faces Pain Scale-Revised, and the Coloured Analogue Scale for acute pain, rated the Wong-Baker scale well established but only weakly recommended, and recommended no measure for children under six (Birnie and colleagues); a 2017 systematic review found no evidence that three-year-olds and weak evidence that four-year-olds can use any published self-report scale validly (von Baeyer and colleagues); and the verbal numeric scale was strong for ages 6 to 17 but not for 4 and 5 in emergency department data (Tsze and colleagues, 2018). Agreement between the Wong-Baker scale and a visual analogue scale was rho 0.90 in 120 emergency patients (Garra and colleagues, 2010), a group-level result that does not make an individual FACES value equal to a numeric one. No published audit counts how often a chart entry omits the scale name or records a FACES rating as an observer's judgment; the Foundation's use conditions and the Joint Commission criteria described under compliance considerations are what turn those omissions into a defensibility problem. The BastionGPT Clinical Advisory Board sees the same errors most often in Wong-Baker FACES documentation reviews:
BastionGPT is specifically trained, tuned, and clinically tested on pain assessment and nursing documentation.
See how clinicians use it day to day on the AI medical notes page.
Many BastionGPT users report saving more than 90 minutes per day on documentation.
HIPAA-compliant with a signed BAA on every plan. Your data is never used to train models. BastionGPT drafts, you review and sign.
The patient chooses one of six faces and the clinician records the number that belongs to it on a 0 to 10 metric in steps of two, so a valid entry is 0, 2, 4, 6, 8, or 10. The original 1980s version was scored 0 to 5; the Foundation now uses the 0 to 10 metric so that the values sit on the same range as the numeric rating scale, which is why older forms and some study reports still show 0 to 5. The Foundation states that the scale is for people ages three and older, that it measures physical pain only, and that it may not be modified or colored. The artwork and the scripted instructions are the Foundation's copyrighted material and are not reproduced here; administer the scale from the Foundation's licensed material, and in the chart record the scale name, the value, that the patient selected it, and the time.
The patient, always. The Foundation states that the scale is a self-assessment tool, that it is not to be used by a third person, whether a parent, a caregiver, or a health professional, to assess the patient's pain, and that it should never be used with unresponsive patients or to compare the patient's face to the scale. A nonverbal adult who understands the task and can point can use it; an adult who is sedated, delirious, or otherwise unable to understand cannot, and the ASPMN position statement's hierarchy applies: attempt self-report, consider conditions likely to cause pain, observe behavior with a validated observational tool (the CPOT in intensive care, the PAINAD in advanced dementia, the FLACC in young children), obtain a proxy report labeled as such, and consider an analgesic trial. Document the switch and the reason in the note. In critical care the arousal assessment that decides whether self-report is possible at all is the RASS, and a positive CAM-ICU is a reason to doubt that a chosen face means what it would in an alert patient.
The Foundation states ages three and older, adults included. The evidence is more graded than that: a 2017 systematic review found no evidence that three-year-olds and only weak evidence that four-year-olds can use any published self-report scale validly, IASP commentary places strong evidence at five and older, and the 2019 quality assessment of pediatric measures recommended no measure for children under six. For numbers, Tsze and colleagues found the verbal 0 to 10 scale strong for ages 6 to 17 and not strong at 4 and 5, and von Baeyer and colleagues tentatively supported it from age 8. In practice: offer the numeric scale to a school-age child who can explain what a number would mean and use FACES when they cannot; use FACES or the Faces Pain Scale-Revised for younger children who understand the task; use an observational tool below that; and for adults offer numbers first and move to a faces scale when language, literacy, hearing, or cognitive change gets in the way, remembering that the cognitively impaired older adults in Ware and colleagues' study preferred a faces scale. Whatever you choose, write the reason, and keep the same tool for the same patient unless their ability changes.
Seven elements, one or two chart lines each: the scale named and the reason it was chosen over a numeric or observational tool; the rating written as the patient's choice with the time (Wong-Baker FACES 8, patient selected at 16:25); location, onset, character in the patient's words, and what makes it worse or better; a comfort and function goal agreed with the patient or family; the intervention with drug, dose, route, and time, or the nonpharmacologic measures used; a reassessment timed to the route on the same scale, again patient selected, with the function result and side effects; and a trend that contains only FACES values, with any parent impression or behavioral observation recorded beside the rating rather than in place of it. The sample on this page shows all seven in an emergency department visit, and the blank template carries them as fields.
No, and no. Both scales run 0 to 10, and at the group level they agree well (Garra and colleagues found rho 0.90 against a visual analogue scale in 120 emergency patients), but a FACES value is a choice among six pictures with emotional cues at the anchors and a numeric value is a count the patient generates, and no authority treats them as interchangeable for an individual. Chambers and colleagues showed that faces scales with emotion-laden anchors produce higher ratings than neutral scales, which is the kind of systematic difference that makes a mixed trend misleading. Keep FACES values in their own trend, name the scale beside every number, and when the tool changes because the patient's ability changed, start a new labeled trend and write why. If your electronic record maps both scales into one pain score field, raise it with informatics, because that field produces exactly the mixed trend this page warns against.
None of the three. In the United States, the Medicare Conditions of Participation require a current nursing care plan and complete, dated, timed, authenticated records and name no pain tool (LAW); California requires licensed facilities to assess pain in a consistent manner appropriate to the patient and note it in the chart, and since 2018 no longer ties that assessment to vital signs (LAW, California only). The Joint Commission's PC.01.02.07 requires an organization to define its own criteria to screen, assess, and reassess pain consistent with the patient's age, condition, and ability to understand, and to document the response to interventions and progress toward functional goals; it names no tool and no interval, it stated in 2016 that it does not endorse pain as a vital sign and never required treating pain to a number, and it removed the requirement to assess pain in all patients from hospital accreditation in 2009 (CONVENTION with accreditation force). CMS removed the pain questions from the HCAHPS survey for discharges from October 1, 2019 (PAYER POLICY). In Canada, CAN/HSO 13200:2023 asks for consistent documentation of pediatric pain assessment and does not prescribe an approach; in Australia, the 2022 opioid stewardship clinical care standard carries a quality statement on acute pain assessment and the NSQHS standards name no tool. The 15 to 30 minute and 45 to 60 minute reassessment windows are conventions from drug onset in the AHRQ patient safety chapter, and the idea that a rating above 4 must be medicated appears in no standard. Follow your policy, cite it in the note, and name the trigger for each reassessment.
Chart each as what it is. The child's choice is the self-report and stays in the record as chosen: "Wong-Baker FACES 10, patient selected at 14:05," followed by the observation in its own clause: "playing with blocks, moving freely, no guarding." Do not replace the rating with your reading of the behavior; children choose the top of the scale for fear as well as pain, and the emotion-laden anchors push some choices upward, which is a reason to record both and decide the response clinically. A parent's number is a proxy impression: write it as one ("mother estimates his pain as moderate") and never in the patient's pain score field. A sleeping child cannot choose a face, so no value is entered; describe the sleep and the breathing, note the time, and reassess with the same scale when the child wakes. When an opioid was given, sleep is also the moment to record a sedation score such as the POSS, because sedation precedes respiratory depression and a quiet child is not proof of comfort.
Only with the Foundation's permission or license. The artwork is copyrighted, Wong-Baker FACES is a registered trademark of the Wong-Baker FACES Foundation, and the Foundation's pages state that use in facilities, commercial products, or publications will likely need a licensing agreement and fee, that healthcare organizations request a quote through its licensing form, that personal permission is granted through a separate form, that no modifications may be made and no colors added, and that reproductions carry its copyright caption. Its pages also say that licensing is not required for every situation, but they publish no blanket free grant for facility forms, electronic record builds, apps, or websites, and the fact that colorized copies circulate online is not permission. What needs no license is the concept: a field for the value, your own documentation prompts in original words, and the structure on this page. If you need a faces scale you can reproduce without a fee, the Faces Pain Scale-Revised is owned by the International Association for the Study of Pain, which states that no permission is required for clinical, educational, or research use provided it is not modified, with commercial use licensed separately; it is a different scale with different anchors, so name it and do not trend it against Wong-Baker values.
Yes. Give it the facts (the scale used and why, that the patient chose the face and when, the pain location, onset, character, and what changes it, the function goal, the intervention with dose, route, and time, the reassessment value and time on the same scale, the observed behavior and any parent impression, and the plan) and it drafts the full entry: scale and reason, patient-selected rating, assessment in the patient's words, goal, intervention, timed reassessment, observations kept separate from the rating, and the trend and communication lines, ready for your review. It can also check a finished entry for a rating with no scale named, an observer-rated or proxy value written as self-report, a number with no location or onset, an intervention with no timed reassessment, a sleeping patient scored, or FACES and numeric values mixed in one trend. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.
The instrument facts and compliance claims on this page trace to these sources, last verified September 2026:
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.