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Does a pain scale improve pain assessment in the pediatric emergency department?
Carl P Kaplan1, Cristina Sison, Shari L Platt
1Department of Pediatrics, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA. ckaplanmd@gmail.com
Insights
Integrating the Wong-Baker FACES pain scale (WBFPS) into electronic medical records (EMR) significantly improved pain documentation in pediatric emergency departments. However, this did not lead to better or faster pain management for children.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Informatics
- Pain Management
Background:
- Effective pain assessment in children is crucial for timely management.
- The Wong-Baker FACES pain scale (WBFPS) is a validated tool for pediatric pain assessment.
- Electronic medical record (EMR) integration may enhance the use of standardized assessment tools.
Purpose of the Study:
- To evaluate if incorporating the WBFPS into the EMR improves pain documentation in a pediatric emergency department.
- To determine if this intervention impacts the management of pediatric pain patients.
Main Methods:
- The WBFPS was integrated into the EMR system of a tertiary care pediatric emergency department.
- A retrospective review of patient EMRs was conducted 30 days before and after the intervention.
- Pain score documentation rates and time to analgesia administration were compared between pre- and post-intervention groups.
Main Results:
- Pain score documentation increased significantly from 7.4% pre-intervention to 38.2% post-intervention (P < 0.001).
- No significant difference was observed in the rate of analgesia administration for patients with high pain scores (≥6).
- The time to analgesia administration did not show a statistically significant difference between the groups.
Conclusions:
- EMR integration of the WBFPS effectively enhances pain assessment documentation in pediatric emergency settings.
- Despite improved documentation, the integration did not translate to improved analgesia administration rates or reduced administration times.
- Further strategies may be needed to optimize pain management outcomes beyond improved documentation.
Objective:
Pain management in children requires rapid and sensitive assessment. The Wong-Baker FACES pain scale (WBFPS) is a widely accepted, validated tool to assess pain in children. Our objective was to determine whether incorporation of the WBFPS into the emergency medical record (EMR) improves pain documentation in the pediatric emergency department. We also examined whether this intervention improves the management of children who present with pain.
Methods:
The WBFPS was incorporated into the EMR in an urban tertiary care pediatric emergency department. We performed a review of EMRs for patients aged 3 to 20 years at 30 days before and 30 days after the intervention. All physicians were trained to use the WBFPS. We excluded patients younger than 3 years or who were unable to perform the assessment. We compare rates of pain score documentation for the preintervention (PRE) and postintervention (POST) groups and times from triage to analgesia administration using Fisher exact test.
Results:
A total of 462 and 372 EMRs were included in the PRE and POST groups, respectively. The groups were similar with respect to age (P = 0.46); there were more males in the POST group (47.2% vs 56.5%, P = 0.008). The rate of pain score documentation was 7.4% (n = 34) in the PRE group and 38.2% (n = 142) in the POST group (P < 0.001). In patients with pain score of 6 or greater, there was no statistical difference in analgesia administration (PRE, 41.7% [10/24] vs POST, 41.8% [28/67]) or time to administer analgesia in minutes (PRE, 80.4%; median, 42 and POST, 100.5%; median, 52.5; P = 0.71).
Conclusions:
Incorporating the WBFPS into the EMR significantly improves pain assessment in children. Despite this, there was neither improvement in analgesia administration nor reduction in time to administer analgesia in children with pain.
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