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Reducing Time to Pain Medication Administration for Pediatric Patients with Long Bone Fractures in the Emergency
Sarah S Schuman1, Rebecca B Regen1, Lindsay H Stuart1
1Department of Pharmacy, Le Bonheur Children's Hospital, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center.
Insights
A new protocol significantly reduced pain medication time for pediatric long bone fractures, with acetaminophen proving effective as a first-line treatment. This quality improvement project enhances emergency care for children experiencing significant pain.
Area of Science:
- Pediatric Emergency Medicine
- Pain Management
- Quality Improvement
Background:
- Effective pain management is crucial for pediatric long bone fracture treatment.
- Suboptimal pain management in children is a significant public health concern.
- This study addresses the need for timely pain relief in pediatric emergency departments.
Purpose of the Study:
- To develop and implement a protocol to expedite pain medication administration for pediatric long bone fractures.
- To achieve a target median time of ≤47 minutes from emergency department arrival to medication delivery.
- To evaluate the effectiveness of acetaminophen as a first-line analgesic.
Main Methods:
- A multidisciplinary team created a standardized, nurse-initiated protocol using acetaminophen as the first-line agent.
- Protocol compliance was monitored via International Classification of Diseases codes for fractures.
- The study assessed the frequency of second pain medication administration and changes in vital signs and pain scores.
Main Results:
- Implementation reduced the median time to pain medication administration to 26 minutes.
- 63% of patients required a second pain medication dose.
- Opioid administration led to a greater reduction in posttreatment pain scores, though vital signs showed no significant changes.
Conclusions:
- A standardized pain management protocol, coupled with education, significantly decreases medication administration time in pediatric long bone fractures.
- Acetaminophen is demonstrated to be a rapid and effective initial treatment for pain in this population.
- The protocol improves the timeliness and efficacy of pain management for pediatric fracture patients.
Introduction:
Pain management is a critical aspect of effective long bone fracture treatment. Pediatric patients frequently report suboptimal pain management, which is an area of growing public concern. The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures ≤47 minutes of emergency department arrival.
Methods:
A multidisciplinary team developed a standardized protocol for pain management of patients presenting with musculoskeletal pain utilizing acetaminophen as the first-line agent under a nurse-initiated order. Following education and implementation, weekly reports generated using the International Classification of Diseases codes of fractures were reviewed to assess compliance with the protocol. This study evaluates the frequency of a second pain medication administration and reduction in vital signs and pain scores.
Results:
Implementation of a pain management protocol reduced median time to pain medication administration to 26 minutes. Overall, 63% (n = 638) of patients required a second pain medication. Of these, 66.5% (348/523) who initially received acetaminophen and 59.7% (286/479) who initially received an opioid required a second pain medication. No significant changes in pre and posttreatment vital signs were found between groups. Patients who initially received opioids experienced a greater reduction in posttreatment pain scores.
Conclusions:
Using a standardized pain management protocol in combination with comprehensive education effectively reduces median time to pain medication administration in pediatric patients with long bone fractures. Acetaminophen is a rapid and effective first-line agent for managing pain in this population.
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