600 Week 1

Evidence

1. Inadequate analgesia of children in emergency department a, b, c

2. Received analgesia: 48% on ages six months to 24 months; 65% on ages six years to 10 years a

3. Factors affecting pain assessment in children d

4. Documentation of pain scale was 47% on < 4 years old; 34% on < 1 year old e

5. Pain assessment tool specific to children ages 3mos-6yrs f, g, h

6. Pain education program significantly increased both pain score and pain assessment practice i, j, k, l

7. ED Pain data will be available once collected

Outcomes Short Term

Improve documentation of pain assessment

Long Term Improve administration

of pain medication Impact Adequate

pain control

Poor pain control of children

ages 3mos to 6yrs old seen in ED 1

ED Pain Data 7

Inadequate pain management 2, 3

Pain education of nurses 6

Pain assessment, FLACC Scale 5

Lack of triage protocol

Lack of assessment tools -age specific 5

Barriers/myths to treatment of pain 3

Fear of drug addiction

Children not feeling pain

Cultural and sex differences

Personal beliefs and values

Physical setting

Parental influence

Lack of knowledge of providers 5

References

a.Alexander, J. & Manno, M. (2003). Underuse of analgesia in very young pediatric patients with isolated local painful injuries, Annals of Emergency Medicine, 41, 617-622. b.Brown, J., Klein, E., Lewis, C., Johnston, B., & Cummings, P. (2003). Emergency department analgesia for fracture pain, Annals of Emergency Medicine, 42, 197-205. c.Rupp, T., & Delaney, K. (2004). Inadequate analgesia in emergency medicine, Annals of Emergency Medicine, 43, 494-503. d.Bauman, B., & McManus, J. (2005). Pediatric pain management in the emergency department, Emergency Medicine Clinical North America, 23, 394-414. e.Drendel, A., Brousseau, D., & Gorelick, M. (2006). Pain assessment for pediatric patients in the emergency department, Pediatrics, 117, 1511-1518. f.Manworren, R.C., & Hynan, L.C. (2003). Clinical validation of FLACC: Preverbal patient pain scale, Pediatric Nursing, 29, 140-146. g.Kaplan, C., Sison, C., & Platt, S. (2008). Does a pain scale improve pain assessment in the pediatric emergency department? Pediatric Emergency Care, 24, 605-608. h.Probst, B., Lyons, E., Leonard, D., & Esposito, T. (2005). Factors affecting emergency department assessment and management of pain in children, Pediatric Emergency Care, 21, 298-305. i.Twycross, A. (2010). Managing pain in children: Where to from here? Journal of Clinical Nursing, 19, 2090-2099. j.Chiang, L., Chen, H., & Huang , L. (2006). Student nurses’ knowledge, attitudes, and self efficacy of children’s pain management: Evaluation of an education program in Taiwan, Journal of Pain and Symptom Management, 32(1), 82-89. k.LeMay, S., Johnston, C., Choiniere, M., Fortin, C., Kudirka, D., Murray, L., & Chalut, D. (2009). Pain management practices in a pediatric emergency room study: Intervention with nurses, Pediatric Emergency Care, 25, 498-503. l.Rieman, M., Gordon, M., & Marvin, J. (2007). Pediatric nurses’ knowledge and attitudes survey regarding pain: a competency tool modification, Pediatric Nursing, 33, 303-306.