Quality improvement: implementation of a pain management policy in a university pediatric hospital

Until recently, individual doctors and nurses in our pediatric hospital made decisions about the application of pain relief in patients, resulting in a wide variety of practice. The main task of our pain group was to develop hospital-wide practice standards for acute pain management to improve care. One of the key points of the pain policy was the introduction of pain assessment tools (COMFORT and Visual Analogue Scale).

A project team supported by the Institute for Healthcare Improvement (CBO) collaborated during 1 year. The pain policy and in particular, the pain assessment tools, were implemented in the postanesthetic care unit (PACU) and surgical ward. The following targets were set: pain assessment will be performed in 95% of cases and the severity of pain will be 'no or mild pain' in 95% of cases.

During the study period, 37% of all proposed pain assessments could be retrieved. The maximum retrievement score was 68%. In 80% of patients, at least one pain score was retrieved. The scores were divided as follows: 67% no or mild pain, 11% moderate pain, 1% severe pain. In the PACU, over 80% of pain assessments were retrieved; in six study weeks, the aimed score of 95% was reached; 94% of patients reported no or mild pain at departure.

Implementation of a pain policy in a pediatric hospital is a difficult process. Pain management in the PACU fell just short of the set target performances. In the surgical ward, embedding the importance of pain assessment remains a challenge and a prerequisite for quality of care in pain management.