Improvements in pain outcomes in a Canadian pediatric teaching hospital following implementation of a multifaceted knowledge translation initiative
Pain Research and Management, 05/21/2012
Zhu LM et al. – Following KT initiatives, significant improvements in pain processes (pain assessment documentation and pain management interventions) and clinical outcomes (pain prevalence, pain intensity) were observed. Further improvements are recommended, specifically with respect to procedural pain practices and opioid utilization patterns.Methods
- Medical records at The Hospital for Sick Children (Toronto, Ontario) were reviewed on a single day in September 2007.
- Pain assessment and management practices, and pain prevalence and intensity in the preceding 24 h were recorded on a standardized data collection form.
- Where possible, pain outcomes were compared with previous audit results.
- Records of 265 inpatients were audited. Sixty–three per cent of children underwent a documented pain assessment compared with 27% in an audit conducted previously (P<0.01).
- Eighty–three per cent of children with documented pain received at least one pain management intervention.
- Overall, 51% of children received pharmacological therapy, and 15% received either a psychological or physical pain–relieving intervention.
- Of those assessed, 44% experienced pain in the previous 24 h versus 66% in the previous audit (P<0.01).
- Fewer children experienced severe pain compared with the first audit (8.7% versus 26.1%; P<0.01).
- One–third of children received opioids; 19% of these had no recorded pain assessment.
- Among 131 children who underwent a painful procedure, 21% had a concurrent pain assessment.
- Painful procedures were accompanied by a pain–relieving intervention in 12.5% of cases.