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Analgesia protocols for burns dressings: Challenges with implementation
S L Wall1, D L Clarke1, N L Allorto1
1Pietermaritzburg Burn Service Pietermaritzburg Metropolitan Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
Insights
Doctors in peripheral hospitals show significant gaps in pediatric burn pain management knowledge compared to those in academic centers. This highlights a need for standardized training and reinforced protocols to improve patient care quality across all facilities.
Area of Science:
- Medical Education
- Pain Management
- Pediatric Burn Care
Background:
- Analgesia protocols for pediatric burn patients exist but vary in reinforcement.
- A disparity in knowledge regarding pain management for children with burns was investigated.
Purpose of the Study:
- To compare doctors' knowledge of analgesia in pediatric burn patients.
- To assess the impact of protocol reinforcement on pain management practices.
Main Methods:
- Anonymous questionnaires were distributed to doctors managing pediatric burn patients.
- Data was collected from doctors in an academic hospital and peripheral referral hospitals.
Main Results:
- Doctors in the academic center demonstrated superior knowledge of ketamine dosing for procedural sedation compared to referral hospital doctors (80% vs. 8%).
- Significant differences were observed in the choice of procedural sedation agents (ketamine use: 100% vs. 39%) and assessment methods for pain adequacy.
- Referral doctors were less likely to use standardized scoring systems, with some relying on indicators like a child screaming.
Conclusions:
- A significant knowledge gap exists between academic burn centers and peripheral referral hospitals regarding pediatric burn analgesia.
- This discrepancy directly impacts the quality of pain management received by pediatric burn patients.
- Standardizing care and reinforcing protocols across all institutions are crucial for improving outcomes.
Background:
The aim of this study is to compare doctors' knowledge regarding analgesia in paediatric burns patients in a setting where analgesia protocols are provided but not reinforced to a setting where the same protocols are used but with constant re-enforcement from burns surgeons.
Methods:
We reviewed questionnaires completed anonymously by doctors managing burns children in the Pietermaritzburg (PMB) Hospital Complex and the referral hospitals.
Results:
The questionnaire was completed by 43 doctors with 53% of the participants working in the referral hospitals. Procedural sedation was given by 98% of doctors. All PMB doctors giving procedural sedation used ketamine compared to 39% in the referral hospitals, which was statistically significant (×2 = 18.237; p < 0.001). Eighty percent of PMB doctors were aware of the correct doses of ketamine and compared to 8% of referral doctors. This was statistically significant (×2 = 21.778; p < 0.001). When assessing the adequacy of analgesia, all of the doctors from PMB used a scoring system or clinical impression. In the referral doctor group, 54% used a scoring system, 38% used the child screaming as an indicator of inadequate analgesia.
Conclusion:
We have identified a discrepancy in knowledge between staff in an academic burn centre and those in peripheral referral hospitals. This discrepancy translates into differences in quality of burn analgesia which patients receive. Ongoing efforts must be directed towards changing the culture of district institution and strengthening attempts to standardize care across the region.
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