Background - Satisfactory pain control is associated with faster recoveries, fewer complications, increased patient satisfaction and reduced length of stay. In a recent paper, following implementation of knowledge translation... [ view full abstract ]
Background - Satisfactory pain control is associated with faster recoveries, fewer complications, increased patient satisfaction and reduced length of stay. In a recent paper, following implementation of knowledge translation (KT) initiatives at a pediatric hospital in Toronto, significant improvements in pain processes and clinical outcomes were observed. Survey data show that our parents’ satisfaction with pain control at UCD children’s hospital is below goal and below the national benchmark and currently, the children’s hospital does not have a comprehensive pain service. This project aims to understand the state of pain management/assessment practices at UCD Children’s Hospital, to implement knowledge translation initiatives and to propose a plan for a comprehensive pediatric pain service.
Methods - Single day retrospective chart audits were conducted to assess clinical outcomes (pain prevalence and pain intensity) and process outcomes (assessment and management practices). Each unit had varying process outcomes due to differences in the patient population and needs of each unit. EMR nursing flowsheets and chart records were analyzed to determine frequency and method of pain assessment, and when nurses choose to administer pain interventions. The information gained from these audits was used to assess deficiencies and areas of improvement for pain management. KT initiatives were implemented over several months: five 1 hour education sessions for pediatric ward nurses were held addressing pediatric pain management strategies. Process review sessions were held amongst pediatric anesthesiologists to review and update current practices and to implement a common practice to educate parents about pain management expectations. Child life specialists implemented improved pain education programs and preoperative education material was developed to improve education of families and patients prior to their surgical day. Study of the intervention will be measured via patient satisfaction surveys, as well as a repeat audit of the same clinical and process outcomes.
Results - Records of 102 pediatric inpatients in 4 different units were audited and all patients had documented pain scores. CSC had 10.5% patients with poorly controlled pain (defined as two or more moderate to severe pain scores in 24 hours) compared to 20.5% in Davis 7, 11.4% in the NICU and 35.7% in the PICU. Of patients with documented pain, 90% of children received pharmacological therapy, and 31% received either a psychological or physical pain-relieving intervention. Deficiencies included charting discrepancies using different pain scales (FLACC, NPASS, Wong Baker Faces) for the same patients and failure to chart pre/post pain scores after pain interventions.
Conclusions - The KT initiatives and improvements in pain practices have been and will continue to be implemented and survey data thus far indicates the possibility of positive impact to patient satisfaction with pain management; more data is likely needed to provide conclusive evidence of the effectiveness of this program. Improvement in quality measures is not the final aim of this project. The next steps are aimed at forming a multidisciplinary, comprehensive pediatric pain service to provide consultation for the entire children’s hospital for acute, perioperative, chronic, and palliative pain management.
