Observation of Emergency Room Nurses Managing Pediatric Pain: Care to Be Given… Care Given…

Impact of a Strategy for Improving Early Management of Acute Pain in the Pediatric Emergency Department

OBJECTIVES

The objective of this study was to measure the impact of an intervention on pain treatment in a pediatric emergency department (ED). The application of interventions to improve pain management in DE has demonstrated diverse effects so far, most of them successful.

METHODS

This is a quasi-experimental before-and-after, longitudinal, prospective study.Patients were collected between January 2020 and December 2021. Principal outcome was the number of patients with moderate or severe pain who received analgesia before 30 minutes to the ED arrival. The intervention consisted of several training sessions for nursing staff, pediatricians, and trauma physicians.

RESULTS

A total of 515 patients were enrolled, 230 during preintervention period and 285 during postintervention period. The percentage of patients receiving analgesia before 30 minutes increased from 24% to 29% and before 60 minutes increased from 31% to 42%. Time to analgesia administration decreased from 43 to 39 minutes.Only 254 patients (49%) received analgesia at some point during their stay in the ED, 137 (26.6%) before 30 minutes and 193 (37.5%) before 60 minutes. The probability of receiving analgesia was greater in patients seen by a pediatrician rather than an orthopedist (59%-37%). Metamizole was the most commonly used drug (48%), followed by ibuprofen and acetaminophen.

CONCLUSIONS

The application strategies to enhance early pain treatment in the ED can improve analgesia administration. Training strategies aimed at healthcare personnel working in the ED can change the way they work and achieve clear benefits for the patient. The treatment of pain in the ED should begin as soon as possible, and in this objective, the involvement of the nursing staff is a priority, because they are the professional who has the best opportunity for the detection and treatment of pain from the moment of triage.

Predictors of triage pain assessment and subsequent pain management among pediatric patients presenting to the emergency department

BACKGROUND

Pediatric patients with pain of various causes present to the emergency department. Appropriate assessment and management of pain are important aspects of emergency department treatment. However, only a few studies have identified the predictors of both outcomes. This study aimed to evaluate the rate of pain assessment at triage and subsequent management and to identify the predictors of each outcome.

METHODS

This was a multi-center retrospective study based at five community emergency departments. Pediatric patients (< 18 years) with pain or injury who presented to the emergency department between February 2018 and May 2018 were included. In addition to patient demographics, the initial pain assessment at triage, reason for visit, and time to analgesia were determined. Further, the type and route of analgesia were identified in patients who received analgesia. Univariate and multivariable regression models were used to identify predictors of pain assessment and management.

RESULTS

There were 4,128 patients with an average age of 9.6 years, and 49.1% of them were female. Only 74.2% of the patients underwent assessment for pain at triage, and 18.3% received analgesia. The median time to analgesia was 95 (IQR: 49-154) min. Most patients presented with head/neck (36.1%), upper limb (21.6%), and lower limb (19.9%) pain. The oral route was the most common analgesia delivery method (67.4%), and ibuprofen and acetaminophen were the primary agents used. Younger age, higher acuity, and presenting with head or neck pain were independent predictors of pain assessment at triage, while children 3-5 years and those with lower extremity pain were more likely to receive analgesia.

CONCLUSION

Although pain assessment at triage has improved in pediatric patients, there is still a major deficiency in adequate pain management. Our study highlights predictors of pain assessment and management that can be considered for improved pediatric care.

The effect of evidence-based pain assessment protocol in pediatric emergency department on nurses' knowledge, attitudes, and practices towards pain

PURPOSE

This study aimed to determine the effect of the "Evidence-Based Pain Assessment Protocol in Pediatric Emergency Department" on nurses' knowledge, attitudes, and practices towards pain.

METHOD

A pretest-posttest quasi-experimental study was conducted with 11 nurses. Before the protocol was applied, 337 nurses' records were assessed for one month. Subsequently, the nurses were educated in the Evidence-Based Pain Assessment Protocol in the Pediatric Emergency Department. After the education, the researchers assessed 315 nurses' records for one month to evaluate the protocol's effect on the nurses' clinical practice.

RESULTS

The study found no significant difference in the mean scores of nurses' Pediatric Pain Knowledge and Attitude Scale between the pre-and post-education periods (p > 0.05). However, there was a significant difference in the types of pain assessment tools used between these two periods (p < 0.001). In the post-education period, the frequency of both pharmacological and non-pharmacological interventions implemented increased significantly compared to the pre-education period (p < 0.001). Additionally, the study found that the frequency of nurses describing pain and reassessing pain increased significantly in the post-education period compared to the pre-education period (p < 0.001).

CONCLUSIONS

The study found that there was no significant change in the nurses' Pediatric Pain Knowledge and Attitude Scale scores before and after the training. However, it was observed that the frequency of nurses reassessing pain, using non-pharmacological interventions, and describing pain increased after the protocol was applied in the emergency department. In particular, therapeutic communication and the walking method were used more frequently in the post-training period among the non-pharmacological interventions applied by the nurses for pain.

Assessment and pain management during the triage phase of children with extremity trauma. A retrospective analysis in a Pediatric Emergency Room after the introduction of the PIPER recommendations

Background and aim of the work:

Pain is one of the most common symptoms in children who access the Pediatric Emergency Room (PER). However, many studies show that it is poorly evaluated and treated during the triage phase and that in many cases algometric scales aren’t used for its evaluation. Faced with this, the Piacenza PER (Italy) implemented the Pain in Pediatric Emergency Room (PIPER) recommendations for the assessment and management of pain from the 1st July 2017. The aim of this study was to detect the possible differences in the trend of the outcomes for the detection and treatment of pain in July-October 2016, 2017, 2018.

Methods:

A retrospective observational study was chosen. 811 discharge letters of extremity traumatized children aged 0-9 years were analyzed, of which 309 referred to the 2016 quarter, 243 to the 2017 quarter and 259 to the 2018 quarter.

Results:

In 2016, the pain of 12 patients was assessed out of a total of 309, in 2017 of 227 out of 243 and in 2018 of 245 out of 259. The Chi Square test about assessed and not assessed pain, gave statistically significant value (p = 1.36E-98), comparing 2016vs2017 and gave not significant value comparing 2017vs2018 (p = 0.58). 4 patients were treated during the triage phase in 2016, 68 in 2017 and 70 in 2018.

Conclusions:

Recommendations introduction has increased the frequency of pain algometric measurements during the triage phase by leading to an improvement in the nursing care outcomes in terms of pediatric pain management. (www.actabiomedica.it)