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Using quality improvement strategies to enhance pediatric pain assessment
Marsha J Treadwell1, Linda S Franck, Elliott Vichinsky
1Sickle Cell Center, Children's Hospital Oakland, CA 94609, USA. mtreadwell@mail.cho.org
Insights
Implementing quality improvement strategies enhanced pediatric pain assessment and management. This led to increased patient and staff satisfaction with pain care and documentation compliance.
Area of Science:
- Pediatric healthcare quality improvement
- Pain management in children
- Patient safety in hospitals
Background:
- Effective pain assessment is crucial for pediatric inpatients.
- Current pain assessment practices may not always be developmentally appropriate.
- Quality improvement initiatives can address gaps in pain management.
Purpose of the Study:
- To assess the impact of a quality improvement (QI) approach on implementing developmentally appropriate pain assessment guidelines for pediatric inpatients.
- To evaluate patient and staff satisfaction with pain assessment and management one year post-implementation.
- To measure changes in staff documentation of pain assessment.
Main Methods:
- A quasi-experimental design was used in a pediatric hematology/oncology unit.
- Staff received education on pediatric pain assessment tools and a standardized protocol.
- Patient/caregiver and staff questionnaires were administered before and one year after implementation.
Main Results:
- Patients, families, and staff reported increased pain assessment and improved responsiveness to pain.
- Satisfaction with pain assessment tools and management significantly increased.
- Chart audits confirmed improved compliance with pain assessment documentation.
Conclusions:
- Quality improvement strategies effectively enhance pediatric pain assessment and management.
- Sustained improvements in pain care lead to increased patient and staff satisfaction.
- Implementing standardized, developmentally appropriate guidelines is achievable and beneficial.
Objective:
To evaluate the impact of a quality improvement approach to implementing developmentally appropriate pain assessment guidelines for pediatric inpatients. Patient and staff satisfaction with pain assessment and management, and staff documentation were evaluated one year following the implementation of the revised pain assessment guidelines.
Design:
Quasi-experimental design.
Setting:
The pediatric hematology/oncology unit of a regional children's hospital. Study participants. A convenience sample of 36 children and 68 staff at time 1 (TI) and 49 children and 82 staff at time 2 (T2).
Interventions:
Staff were educated on the use of pediatric pain assessment tools and a standardized pain assessment protocol was put into practice. Children or their primary caregivers were interviewed, using a questionnaire modified from the American Pain Society quality assurance guidelines, regarding their experiences with pain assessment and management on the unit at T1, just prior to the staff education, and one year later at T2. Multidisciplinary unit staff completed a parallel questionnaire at T1 and T2.
Main Outcome Measures:
Patient and staff satisfaction with pain assessment and management, and chart audit of compliance with pain assessment documentation.
Results:
Patients, family members, and staff reported increased pain assessment, improved staff responsiveness to patients' pain and greater satisfaction with assessment tools between TI and T2. Increased compliance with the assessment guidelines was confirmed by chart audit.
Conclusions:
Improved pain assessment and management practices with resultant increase in patient and staff satisfaction can be achieved and sustained over time using quality improvement strategies.