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Agreed local clinical guidelines should be in use which have been produced by an appropriately constituted multiprofessional team, comprising anaesthetists, specialist nurses, surgeons, critical care clinicians, pharmacists, specialty consultants and managers.  These guidelines should cover at least the following:

• assessment and management of pain and itch, including the recording of pain and itch scores^11,58
• sedation for painful...

Specific arrangements and guidelines should be available, where applicable, for the management of subgroups of vulnerable adult patients, including:

• critically ill patients
• elderly and/or frail patients^50,51
• non-native English speakers
• patients with chronic pain
• patients with coexisting mental health problems
• patients with dementia
• patients with multiple trauma or significant blunt chest wall trauma
• patients with opioid tolerance^52...