Improving pain management for pediatric patients undergoing nonurgent painful procedures

Cregin, Regina; Rappaport, Alisha S; Montagnino, Gina; Sabogal, Gonzalo; Moreau, Harry; Abularrage, Joseph J.

doi:10.2146/ajhp070094

Cited by 19 publications

(8 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Evidence suggests the implementation of an institutional policy change or a unit/department-based protocol actually increases nursing adherence to procedural pain management and improves child procedural pain outcomes [8,18,19,[40][41][42][43]. In a clinical report focused on pain management and anxiety reduction among pediatric patients, the AAP (2004) [22] argued, "a systematic approach to the management of pain, including staff education and protocol development, can enhance comfort among children in the emergency setting" (p. 1348).…”

Section: Recommendation For Practice: Adopt a Procedural Pain And Commentioning

confidence: 99%

Inadequate Pediatric Procedural Pain Management in the Emergency Room: A Policy Analysis

Bice¹

2017

Sch J Emerg Med Crit Care

View full text Add to dashboard Cite

Purpose: Within the provisions of the Patient Protection and Affordable Care Act (PPACA) are specific guidelines on advancing science related to patient pain outcomes. Invasive painful procedures are a common part of pediatric nursing. Many children experience unrelieved procedural pain while in the emergency or urgent care setting. In this paper the following health policy issue is analyzed: underutilization of pain and comfort management in the emergency care setting among children during painful procedures. Design and methods: Using a formal policy analysis method, consideration of: criteria, related factors, and key stakeholders were completed. A proposal for adopting evidence-based clinical practice guidelines was made. This recommendation was evaluated with four essential criteria including: cost, effectiveness, timeliness, and administrative ease. Findings: Political, social, economic, and ethical factors exist which affect the issues of inadequate pediatric procedural pain and comfort management in emergency care. Evidence suggests implementation of an institutional policy change or a unit/department-based protocol will improve nurse utilization of procedural pain treatments. Conclusion: The issue of inadequate pediatric procedural pain management in emergency departments can be appropriately addressed by institutional implementation of evidence-based practice and policy guidelines. This action has been shown to increase nursing adherence with procedural pain management and improve child procedural pain outcomes. Clinical relevance: Increasing nursing utilization of pediatric procedural pain treatment through policy implementation will improve child health and overall quality of life.

show abstract

Section: Recommendation For Practice: Adopt a Procedural Pain And Commentioning

confidence: 99%

Inadequate Pediatric Procedural Pain Management in the Emergency Room: A Policy Analysis

Bice¹

2017

Sch J Emerg Med Crit Care

View full text Add to dashboard Cite

show abstract

“…A multidisciplinary approach involving leadership, MDs, and RNs increased compliance with the newly developed protocol. 16 Physician buy-in was a barrier in our project. Some physicians believed that EMLA did not relieve patients' anxiety, EMLA is not worth the wait, and sedation can be used instead.…”

Section: Discussionmentioning

confidence: 99%

“…This improved physicians' buy-in and compliance. 16 Moreover, although procedural sedation in the ED is generally safe and gives better anxiety and pain relief, adverse effects sometimes occur and include hypoxia, apnea, and vomiting. 17 In addition, patients receiving procedural sedation usually have a longer LOS and higher costs.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department

Faris,

Mesto,

Mrad

et al. 2023

Pediatr Emer Care

View full text Add to dashboard Cite

Objectives Caring for pediatric lacerations in the emergency department (ED) is typically painful because of irrigation and suturing. To improve this painful experience, we aimed to increase the use of a topical anesthetic, Eutectic Mixture of Local Anesthetics (EMLA) on eligible pediatric lacerations with an attainable, sustainable, and measurable goal of 60%. The baseline rate of applying topical anesthetic to eligible lacerations was 23% in our ED. We aimed to increase the use of topical anesthetics on eligible pediatric lacerations to a measurable goal of 60% within 3 months of implementing our intervention. Methods We conducted a prospective, single-center, interrupted time series, ED quality improvement project from November 2019 to July 2020. A multidisciplinary team of physicians and nurses performed a cause-and-effect analysis identifying 2 key drivers: early placement of EMLA and physician buy-in on which we built our Plan, Do, Study, and Act (PDSA) cycles. We collected data on number of eligible patients receiving EMLA, as well as patient and physician feedback via phone calls within 2 days after encounter. Balancing measures included ED length of stay (LOS), patient and physician satisfaction with EMLA, and adverse effects of EMLA. Results We needed 3 PDSA cycles to reach our goal of 60% in 3 months, which was also maintained for 5 months. The PDSA cycles used educational interventions, direct provider feedback about noncompliance, and patient satisfaction results obtained via phone calls. Balancing measures were minimally impacted: 75% good patient satisfaction, no adverse events but an increase in LOS of patients who received EMLA compared with those who did not (1.79 ± 0.66 vs 1.41 ± 0.83 hours, P < 0.001). The main reasons for dissatisfaction for physicians were the increased LOS and the preference for procedural sedation or intranasal medications. Conclusions With a few simple interventions, our aim of applying EMLA to 60% of eligible pediatric lacerations was attained and maintained.

show abstract

“…Cregin et al developed a topical analgesia protocol to decrease pain in nonurgent painful procedures for pediatric patients. A multidisciplinary approach involving leadership, MDs, and RNs increased compliance with the newly developed protocol [16].…”

Section: Discussionmentioning

confidence: 99%

Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department: A Quality Improvement Project

Sawaya

Faris

Mrad

et al. 2021

Preprint

View full text Add to dashboard Cite

Background Caring for pediatric lacerations in the Emergency Department (ED) is typically painful because of irrigation and suturing. To improve this painful experience, we aimed to increase the use of a topical anesthetic, Eutectic Mixture of Local Anesthetics (EMLA) on eligible pediatric lacerations with an attainable, sustainable, and measurable goal of 60%. Local Problem The baseline rate of applying topical anesthetic to eligible lacerations was 23% in our ED. We aimed to increase the use of topical anesthetics on eligible pediatric lacerations to a measurable goal of 60% within 3 months of implementing our intervention. Methods We conducted a prospective, single center, interrupted time series, ED quality improvement project from November 2019 to July 2020. A multidisciplinary team of physicians and nurses performed a cause-and-effect analysis identifying two key drivers: early placement of EMLA and physician buy-in on which we built our Plan, Do, Study, and Act (PDSA) cycles. We collected data on number of eligible patients receiving EMLA, as well as patient and physician feedback via phone calls within 2 days post encounter. Balancing measures included ED length of stay (LOS), patient and physician satisfaction with EMLA, and side effects of EMLA. Results We needed 3 PDSA cycles to reach our goal of 60% in 3 months, which was also maintained for 5 months. PDSA cycles used educational interventions, direct provider feedback about non-compliance and patient satisfaction results obtained via phone calls. Balancing measures were minimally impacted: 75% good patient satisfaction, No adverse events but an increase in LOS of patients who received EMLA compared to those who did not (1.79 +/- 0.66 VS 1.41 +/- 0.83 hours, p<0.001). The main reasons for dissatisfaction for physicians were the increased LOS and the preference for procedural sedation or intranasal medications. Conclusion With a few simple interventions, our aim of applying EMLA to 60% of eligible pediatric lacerations was attained and maintained.

show abstract

Improving pain management for pediatric patients undergoing nonurgent painful procedures

Abstract: A multidisciplinary approach to protocol development and implementation significantly increased compliance to a topical analgesia protocol for pediatric patients undergoing nonurgent painful procedures in a community medical center.

Cited by 19 publications

References 18 publications

Inadequate Pediatric Procedural Pain Management in the Emergency Room: A Policy Analysis

Inadequate Pediatric Procedural Pain Management in the Emergency Room: A Policy Analysis

Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department

Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department: A Quality Improvement Project

Contact Info

Product

Resources

About