Pain Experience in a US Children’s Hospital: A Point Prevalence Survey Undertaken After the Implementation of a System-Wide Protocol to Eliminate or Decrease Pain Caused by Needles

Postier, Andrea; Eull, Donna; Schulz, Craig; Fitzgerald, Maura; Symalla, Barbara; Watson, David; Goertzen, Lexie; Friedrichsdorf, Stefan J.

doi:10.1542/hpeds.2018-0039

Cited by 35 publications

(24 citation statements)

References 40 publications

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“…We identified a strong aversion to children experiencing pain from investigations. While observational data suggest the likelihood of venepuncture during the management of paediatric febrile illness is low,17 pain from procedures including venepuncture is often the most traumatic experience when a child’s primary symptom is fever, impacting patient experience significantly 23 24. Additionally, studies demonstrate that parents tend to overestimate pain experienced by their children,25–27 and therefore our findings suggest that while pain from venepuncture may be expected to last a few minutes, pain from obtaining a single drop of blood from a finger prick for POC testing may be more favourable, thereby improving the experiences for both parents and children.…”

Section: Discussionmentioning

confidence: 72%

What matters when managing childhood fever in the emergency department? A discrete-choice experiment comparing the preferences of parents and healthcare professionals in the UK

et al. 2020

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Background Fever among children is a leading cause of emergency department (ED) attendance and a diagnostic conundrum; yet robust quantitative evidence regarding the preferences of parents and healthcare providers (HCPs) for managing fever is scarce. Objective To determine parental and HCP preferences for the management of paediatric febrile illness in the ED. Setting Ten children's centres and a children's ED in England from June 2018 to January 2019. Participants 98 parents of children aged 0-11 years, and 99 HCPs took part. Methods Nine focus-groups and coin-ranking exercises were conducted with parents, and a discrete-choice experiment (DCE) was conducted with both parents and HCPs, which asked respondents to choose their preferred option of several hypothetical management scenarios for paediatric febrile illness, with differing levels of visit time, out-of-pocket costs, antibiotic prescribing, HCP grade and pain/discomfort from investigations. Results The mean focus-group size was 4.4 participants (range 3-7), with a mean duration of 27.4 min (range 18-46 min). Response rates to the DCE among parents and HCPs were 94.2% and 98.2%, respectively. Avoiding pain from diagnostics, receiving a faster diagnosis and minimising wait times were major concerns for both parents and HCPs, with parents willing-to-pay £16.89 for every 1 hour reduction in waiting times. Both groups preferred treatment by consultants and nurse practitioners to treatment by doctors in postgraduate training. Parents were willing to trade-off considerable increases in waiting times (24.1 min) to be seen by consultants and to avoid additional pain from diagnostics (45.6 min). Reducing antibiotic prescribing was important to HCPs but not parents. Conclusions Both parents and HCPs care strongly about reducing visit time, avoiding pain from invasive investigations and receiving diagnostic insights faster when managing paediatric febrile illness. As such, overdue advances in diagnostic capabilities should improve child and carer experience and HCP satisfaction considerably in managing paediatric febrile illness.

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Section: Discussionmentioning

confidence: 72%

What matters when managing childhood fever in the emergency department? A discrete-choice experiment comparing the preferences of parents and healthcare professionals in the UK

et al. 2020

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“…Contemporary evidence-based measures for pain and anxiety reduction during pediatric procedures are topical numbing cream, positioning, sucrose feeding or breastfeeding (children age ,1 year), and distraction as part of a multimodal approach. [6][7][8][9][10][11] Therefore, we found it unethical to deprive the children of these measures as part of SOC. In our study, we were not able to detect any difference in VAS pain scores between groups.…”

Section: Discussion Patient Satisfaction and Pain Reduction For Procementioning

confidence: 99%

“…[6][7][8][9][10] Application of these 4 evidence-based measures is considered as standard care during needle procedures in our hospital, for example, during IV induction of anesthesia. 11 Distraction is a powerful measure as part of multimodal approach to acute pain management. [6][7][8][9][10] Distraction can be conducted by any health care worker but can be time and staff consuming.…”

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confidence: 99%

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Immersive Virtual Reality for Pediatric Procedural Pain: A Randomized Clinical Trial

Walther-Larsen

Petersen

Friis

et al. 2019

Hospital Pediatrics

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BACKGROUND AND OBJECTIVES: Pain management in children often is inadequate, and the single most common painful procedure in children who are hospitalized is needle procedures. Virtual reality (VR) is a promising and engaging intervention that may help to decrease anxiety and pain in children undergoing painful procedures. Our aim for this study is to investigate patient satisfaction and pain reduction by using a three-dimensional VR interactive game as a distraction. METHODS: In this randomized clinical trial, we enrolled 64 children aged 7 to 16 years who were scheduled for venous cannulation. Patients assigned to the control group were adherent to our standard of care, including topical numbing cream, positioning, and distraction by a specialized pain nurse. In the study group, children were adherent to the standard of care and were distracted by an interactive VR game. Primary outcomes were patient satisfaction and the procedural pain assessed by using a visual analog score; secondary outcomes were the procedural time and any adverse events. RESULTS: We found a high level of patient satisfaction with using the VR custom-made threedimensional interactive game. All children (28 of 28 [100%]) in the VR group answered that they would prefer VR as a distraction for a later procedure, a borderline significant result compared with that of the control group (26 of 31 [84.9%]). No significant difference was found in pain scores and procedural times between the 2 groups. The number of adverse effects was low, with no significant difference between the 2 groups. CONCLUSIONS: We found no difference in pain scores but higher satisfaction when using VR versus standard care as part of a multimodal approach for management of procedural pain in children.

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“…Pain in hospitalized children remains common, under-assessed, and under-treated, with 24 to 80 percent of hospitalized pediatric patients experiencing moderate to severe pain [1][2][3][4][5][6][7][8]. Hospitalized children experiencing severe pain without adequate analgesia show negative long-term consequences, including a higher risk for post-traumatic stress disorder and increased morbidity and mortality [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Post-Cardiotomy Parasternal Nerve Block with Bupivacaine May Be Associated with Reduced Post-Operative Opioid Use in Children: A Retrospective Cohort Study

et al. 2020

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Postoperative pain treatment affects immediate and long-term outcomes in children undergoing cardiac surgery. Opioids, as part of multimodal analgesia, are effective in treating pain, however, they can be disadvantageous due to adverse side effects. Therefore, we assessed whether the local anesthetic bupivacaine as a parasternal nerve block in children post-cardiac surgery is an effective adjunct to pain management. This was a retrospective cohort study of all patients who underwent cardiothoracic surgery via median sternotomy at a large children’s hospital between November 2011 and February 2014 with and without bupivacaine following the introduction of perioperative bupivacaine in late 2012 on a single unit. 62 out of 148 patients (age 3–17 years) who received bupivacaine demonstrated decreased postoperative opioid use. Within one day of surgery, patients who received bupivacaine required, on average, 0.57 mg/kg (95% CI, 0.46 to 0.68) of total morphine equivalent compared to 0.93 mg/kg (95% CI, 0.80 to 1.06) for patients who did not receive bupivacaine. This difference was statistically significant after adjusting for potential confounders (p-value = 0.002). Length of stay and intubation were shorter on average among patients who received bupivacaine, but these differences were not statistically significant after adjusting for potential confounders. The study results seem to suggest that the perioperative administration of bupivacaine may reduce opioid usage among children post-cardiotomy.

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Pain Experience in a US Children’s Hospital: A Point Prevalence Survey Undertaken After the Implementation of a System-Wide Protocol to Eliminate or Decrease Pain Caused by Needles

Abstract: The implementation of a mandatory Comfort Promise protocol used to minimize or prevent pain caused by elective needle procedures was associated with a significant reduction in overall pain prevalence and improved use of evidence-based practices for needle pain management.

Cited by 35 publications

References 40 publications

What matters when managing childhood fever in the emergency department? A discrete-choice experiment comparing the preferences of parents and healthcare professionals in the UK

What matters when managing childhood fever in the emergency department? A discrete-choice experiment comparing the preferences of parents and healthcare professionals in the UK

Immersive Virtual Reality for Pediatric Procedural Pain: A Randomized Clinical Trial

Post-Cardiotomy Parasternal Nerve Block with Bupivacaine May Be Associated with Reduced Post-Operative Opioid Use in Children: A Retrospective Cohort Study

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