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Comfort First: an evaluation of a procedural pain management programme for children with cancer
Maria McCarthy1, Ron Glick, Jessica Green
1Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia. maria.mccarthy@rch.org.au
Insights
The Comfort First Program (CFP) effectively manages pediatric procedural pain and distress, adhering to established guidelines. Regular audits are recommended to maintain high standards in pediatric pain management.
Area of Science:
- Pediatric Pain Management
- Child Psychology
- Healthcare Quality Improvement
Background:
- The Comfort First Program (CFP) offers early intervention for procedural pain and distress in children.
- This study assessed CFP's effectiveness and adherence to Royal Australasian College of Physicians guidelines.
Purpose of the Study:
- To evaluate the Comfort First Program's goal achievement.
- To determine the program's implementation of pediatric pain management guidelines.
Main Methods:
- A single-site cross-sectional audit was performed.
- 135 pediatric patients at a children's hospital were observed.
- An audit tool recorded procedural environment, behaviors, child distress, and interventions.
Main Results:
- Procedures were generally well-prepared, with a median duration of 8 minutes.
- Carers and Comfort First clinicians were present, especially with distressed children.
- Nonpharmacologic supports like distraction were common; younger children received more support.
Conclusions:
- The Comfort First Program effectively implements procedural pain management guidelines.
- Regular audits are advised to ensure ongoing adherence to pain management standards.
Background:
The Comfort First Program (CFP) provides children and their caregivers with early procedural pain management intervention to reduce procedural pain and distress. This study evaluated whether the CFP was meeting its goals and effectively implementing the Royal Australasian College of Physicians paediatric pain management guidelines.
Methods:
The study was conducted as a single-site cross-sectional audit. One hundred and thirty-five patients (mean age 7.7 years) receiving treatment at the Royal Children's Hospital, Melbourne, Children's Cancer Centre Day Oncology Unit were observed. Procedural aspects related to the treatment room, carer and staff behaviour, child distress and use of pharmacologic and nonpharmacologic interventions were recorded using an audit tool developed for the study.
Results:
The procedure room was regularly quiet and prepared before the child entered. Median procedure duration was 8 min. Median procedure wait time was 54 min. At least one carer was typically present during procedures. Comfort First (CF) clinicians were more likely to be present in procedures with a significantly distressed child. Carers, nurses and CF clinicians generally displayed comfort-promoting behaviour. Topical anaesthetic was regularly utilised. Nonpharmacologic supports were frequently used, particularly distraction. Patients under 8 years of age were significantly more likely to receive nonpharmacologic supports and have a carer and CF clinician present. Age was a significant predictor of distress, with higher distress rates in younger children.
Conclusions:
The CFP was found to be effectively implementing procedural pain guidelines. Regular audit is recommended to ensure adherence to pain management standards.
