Toward Better Pain Management: The Development of a "Pain Stewardship Program" in a Tertiary Children's Hospital
B Randall Brenn1, Dinesh K Choudhry2, Karen Sacks3
1Department of Anesthesia and Perioperative Medicine, brbrenn@nemours.org.
Insights
A new pain stewardship program effectively identified pediatric inpatients with uncontrolled pain. This system helps manage pain, improving care and outcomes for children.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Healthcare Quality Improvement
Background:
- Uncontrolled pain remains a significant issue for hospitalized children.
- A proactive approach is needed to identify and manage pediatric pain effectively.
Purpose of the Study:
- To develop and implement a pain stewardship program for hospitalized pediatric patients.
- To establish a framework for overseeing and improving pediatric pain management.
Main Methods:
- Utilized electronic health records to identify patients with average pain scores ≥7.
- Anesthesia pain service reviewed patient charts and categorized required interventions.
- Collected demographic data, pain regimens, and outcomes in a prospectively maintained database.
Main Results:
- Reviewed 843 records from 441 unique pediatric inpatients.
- Only 22% of identified patients required intervention by the anesthesia pain service.
- Patients with sickle cell disease and abdominal pain showed a higher need for attention.
Conclusions:
- An electronic health record-based pain stewardship program is crucial for identifying children with undermanaged pain.
- This system acts as a warning mechanism to enhance patient care, outcomes, and satisfaction.
Objective:
Despite increased focus on pediatric pain, uncontrolled pain is still a problem for hospitalized pediatric inpatients. A program was designed to find patients with uncontrolled pain and develop a framework to oversee their pain management. This report details the development of a pain stewardship program with data from the first year of its activity.
Methods:
Hospitalized inpatients in a tertiary care pediatric center in the mid-Atlantic region were included in the study. Pain scores are recorded every 4 hours in the hospital electronic health record. A report was constructed to find all patients with an average pain score ≥7 in the preceding 12 hours. The charts of these patients were reviewed by our anesthesia pain service, and all patients were grouped into 1 of the following action categories: (1) no action required; (2) telephone call to the patient's attending physician; (3) one-time consultation; (4) consultation with ongoing management; or (5) patient was already on the anesthesia pain service. Demographic data, pain regimens, and outcomes were recorded in a prospectively collected database.
Results:
There were 843 records on 441 unique patients. Only 22% required action to be taken by the anesthesia pain service. The pain stewardship database revealed that patients with sickle cell disease or abdominal pain required more frequent attention.
Conclusions:
An electronic health record-based pain stewardship program is an important step in identifying all children in the hospital with undermanaged pain, and it provides a warning system that may improve patient care, outcomes, and satisfaction.
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