Achieving organizational change in pediatric pain management
Stephanie Dowden1, Maria McCarthy, George Chalkiadis
1Children's Pain Management Service, Department of Paediatric Anaesthesia and Pain Management, The Royal Children's Hospital, and University of Melbourne, Melbourne, Australia. stephanie.dowden@health.wa.gov.au
Insights
Hospital reviews identified key barriers to effective pediatric pain management, including inconsistent practices and knowledge gaps. Institutional support is crucial for implementing changes to improve pain care for hospitalized children.
Area of Science:
- Pediatric Healthcare
- Pain Management
- Organizational Change
Background:
- Undertreatment of pain in hospitalized children is a significant issue.
- Limited guidance exists for improving pediatric pain management practices.
- A hospital-wide review was conducted to address these challenges.
Purpose of the Study:
- To detail the process and outcomes of a comprehensive review of pain management.
- To identify specific deficiencies in pediatric pain service provision.
- To recommend strategies for enhancing pain management in a pediatric hospital.
Main Methods:
- Qualitative research methodology utilizing semistructured interviews with clinical staff.
- Involved 454 staff members from diverse professional backgrounds across hospital units.
- Recommendations formulated by a hospital-appointed working party based on interview findings.
Main Results:
- Procedural and persistent (chronic) pain management requires the most improvement.
- Identified barriers include practice variability, outdated beliefs, and insufficient knowledge.
- The review process led to specific recommendations and subsequent changes.
Conclusions:
- The review successfully identified critical deficiencies and barriers in pediatric pain management.
- Institutional support was instrumental in guiding improvements.
- The study demonstrates a pathway for enhancing pain management in pediatric settings.
Background:
Pain in hospitalized children is often undertreated. Little information exists to guide the process of organizational change with a view to improving pain management practices.
Objectives:
To describe the process and results of a hospital-wide review of pain management practices designed to identify deficiencies in service provision and recommend directions for change in a pediatric hospital.
Design:
Prospective consultation of the clinical staff of a specialist pediatric hospital, using qualitative research methodology involving semistructured individual and group interviews. Recommendations based on the interview findings were made by a hospital-appointed working party.
Results:
A total of 454 staff (27% of all clinical staff) from a variety of professional backgrounds, representing almost every hospital unit or department, were interviewed. Procedural and persistent (chronic) pain was identified as the area needing the most improvement. Barriers to improving pain management included variability in practice, outmoded beliefs and inadequate knowledge, factors which were seen to contribute to a culture of slow or no change. Recommendations of the working party and changes achieved after the review are described.
Conclusion:
The review process identified deficiencies in the management of pain in children, and barriers to its effective management. With institutional support, the present review has guided improvement.
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