Pain Outcomes in a US Children’s Hospital: A Prospective Cross-Sectional Survey

Friedrichsdorf, Stefan J.; Postier, Andrea; Eull, Donna; Weidner, Christian; Foster, Laurie; Gilbert, Michele; Campbell, Fiona

doi:10.1542/hpeds.2014-0084

Cited by 166 publications

(187 citation statements)

References 45 publications

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“…Friedrichsdorf et al had already documented this in a study conducted in the United States, where 40% of the hospitalized children referred needle punctures and blood draws as the maximum or worst pain experienced during hospi-talization 7,20 . It is necessary to establish action protocols in order to avoid this cause of unnecessary pain, including the systematic use of local anesthetics and other non-pharmacological measures such as positioning the child seated, maternal breast or oral sucralose in children under one year and distraction strategies according to age in all cases.…”

Section: Discussionmentioning

confidence: 89%

“…This represents a problem and a major challenge for both professionals who work directly with patients and the management team [9][10][11] . Despite the methodological heterogeneity of international research in this area, it is repeatedly pointed out that pain in hospitalized children and adolescents is a complex health problem and that its approach is still a worldwide challenge [6][7][8][9]10,11 . The literature reports that the most frequent causes of pain during hospitalization are surgical or potentially surgical causes (surgery, postoperative period, trauma, burns, procedures or studies) 6,8,9 .…”

Section: Discussionmentioning

confidence: 99%

“…"Pain management is a clinical act that requires the establishment of good clinical practices, and the lack of training can no longer be an excuse" 5 . International publications note that despite efforts to improve care quality, the assessment and treatment of pain in hospitalized children is still a health problem [6][7][8][9] . There are studies in Uruguay that have identified the same problem 10,11 .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dolor en niños y adolescentes hospitalizados en un centro de referencia

Zunino

Notejane²,

Bernadá

et al. 2018

Rev. chil. pediatr.

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Introduction: The evaluation and treatment of pain in hospitalized is still an important health problem. Objective: To know the prevalence, characteristics and approaches to pain management in children and adolescents hospitalized in the Pediatric Hospital of the Pereira Rossell Center (HP-CH-PR), a pediatric reference center in Uruguay. Patients and Method: Cross-sectional study, through survey and review of clinical records on 09/13/16. All hospitalized children under the age of 19 were included. Variables: age, gender, reason for admission, presence of cognitive disorder, the prevalence of pain at some time during hospitalization, in the last 24 hours and during the interview, cause of maximum pain, intensity, pharmacological and non-pharmacological treatment. Results: 97.4% (152/156) hospitalized children were included. Pain prevalence at some point during hospitalization: 51.3% (78/152, 95% CI: 43.2-59.3); in the previous 24 hours: 39.5% (60/152, 95% CI: 31.7-47.2); during the interview: 15.8% (24/152, 95% CI: 10-21.5). Intensity: mild 13/24, moderate-severe 11/24. Maximum pain referred during hospitalization: needle punctures 48.5% (38/78). They had some analgesic prescription 47.3% of them had some analgesic prescription. Inadequate interdose interval: 45.8%; adequate dose 98.9%; intravenous administration: 43.7%; contraindication to oral route: 40.5%. Conclusions: Regarding children and adolescents hospitalized, 39.5% reported pain 24 hours before being the interviewed and 15.8% reported pain during the interview. The maximum pain reported during hospitalization was due to needle punctures. Children in pain with inappropriate analgesic prescriptions are still detected.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dolor en niños y adolescentes hospitalizados en un centro de referencia

Zunino

Notejane²,

Bernadá

et al. 2018

Rev. chil. pediatr.

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“…and of course, if you ask children what are you most afraid of when coming to see a doctor, whether this is in a clinic or emergency room or children's hospital, hands down the answer is "I am afraid of needle pokes or pricks." The children in our hospital told us in a system-wide survey that the least well-controlled and most distressing pain was caused by needles [8]. We then found strong evidence to offer four modalities [9][10][11][12][13] concurrently to eliminate or reduce needle pain, modalities we now call 'the four non-negotiables'.…”

Section: Interview Friedrichsdorfmentioning

confidence: 99%

Four Steps to Eliminate or Reduce Pain in Children Caused by Needles (Part 1)

Friedrichsdorf

2016

Pain Manag.

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Dr Stefan Friedrichsdorf speaks to Jade Parker, Commissioning Editor: Stefan J Friedrichsdorf, MD, is medical director of the Department of Pain Medicine, Palliative Care and Integrative Medicine at Children’s Hospitals and Clinics of Minnesota, Minneapolis/St Paul, MN, USA, home to one of the largest and most comprehensive programs of its kind in the country. The interdisciplinary pain team is devoted to prevent and treat acute, procedural, neuropathic, psycho-social-spiritual, visceral, and chronic/complex pain for all inpatients and outpatients in close collaboration with all pediatric subspecialties at Children’s Minnesota. The palliative care team also provides holistic care for pediatric patients with life-threatening diseases and adds an extra layer of support to the care of children with serious illness and their families. Integrative medicine provides and teaches integrative (‘non-pharmacological’) therapies, such as massage, acupuncture/acupressure, biofeedback, aromatherapy and self-hypnosis, to provide care that promotes optimal health and supports the highest level of functioning in all individual children’s activities. Children's Minnesota became the first children's hospital to system-wide implement a “Children's Comfort Promise: We promise to do everything to prevent and treat pain,” resulting in decrease or elimination of needle pain caused by vaccinations, blood draws, intravenous access, and injections in more than 200,000 children annually.

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“…Providing effective medical care often involves the risk, or even the certainty, of pain or discomfort that is not easily remedied. Despite the use of pain management strategies, during their hospital admission many children experience pain that is not well controlled [26]. Many medically necessary procedures can be perceived as frightening by young patients, and children in acute care settings are often exposed to sights and sounds that can frighten them (e.g., machines, alarms, and other patients' pain or distress) [21,22].…”

Section: Practice Standards and The Ethical Case For Trauma-informed mentioning

confidence: 99%

What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

Kassam‐Adams¹,

Butler

2017

AMA Journal of Ethics

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Medical experiences can be frightening and traumatic for children. Ill and injured children can experience pediatric medical traumatic stresspsychological and physiological distress responses related to their medical event and subsequent medical treatment experiences-which can lead to symptoms of posttraumatic stress disorder (PTSD) and suboptimal health outcomes. Trauma-informed care provides a framework for acknowledging, addressing, and mitigating the risks of psychological trauma associated with medical treatment experiences and is congruent with the ethical principles of respect for autonomy, beneficence, nonmaleficence, and justice. Health care systems and professionals are encouraged to apply the principles of trauma-informed care to address the effects of pediatric medical traumatic stress. IntroductionFor the sick or injured child, being treated in the emergency department (ED) or admitted to the hospital can be a frightening and confusing experience that leads to subsequent psychological distress [1]. Experiencing pain, feeling helpless and out of control, and being separated from one's parents are all factors that contribute to the potentially traumatic nature of medical events. How does a physician's ethical obligation to "first, do no harm" square with the prospect of providing a therapeutically necessary procedure for a frightened child who does not understand what is being done and why? How do we understand the ethical issues involved when a medically beneficial course of treatment for a pediatric patient also has the potential to engender stress, fear, anxiety, pain, or discomfort for this child? In this brief review, we first describe two concepts that are key to understanding and addressing the psychological distress that can affect ill and injured children: pediatric medical traumatic stress and trauma-informed pediatric care. We then discuss four core principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice [2]) and explain how the application of these principles underscores the need for trauma-informed care.

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Pain Outcomes in a US Children’s Hospital: A Prospective Cross-Sectional Survey

Abstract: Despite existing hospital policies and a pain consult team, significant room for improvement in pain management was identified. A hospital-wide, 3-year Lean quality improvement initiative on reducing pain was commenced as a result of this survey.

Cited by 166 publications

References 45 publications

Dolor en niños y adolescentes hospitalizados en un centro de referencia

Dolor en niños y adolescentes hospitalizados en un centro de referencia

Four Steps to Eliminate or Reduce Pain in Children Caused by Needles (Part 1)

What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

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