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The Kids Pain Collaborative: A Hybrid Type 3 Implementation Effectiveness Study Transforming Paediatric Pain Care in
Suzanne Williams1,2, Samantha Keogh1,3, David Herd4
1Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Insights
A participatory study improved pediatric pain care by enabling nurse-led analgesia and family involvement. This collaborative approach fostered sustainable changes in emergency departments, prioritizing children
Area of Science:
- Implementation Science
- Pediatric Emergency Medicine
- Healthcare Improvement
Background:
- Optimizing pain management in pediatric emergency departments is crucial.
- Existing pain care processes often require enhancement for better patient outcomes.
- Participatory implementation strategies can drive significant improvements.
Purpose of the Study:
- To evaluate a participatory, action-oriented implementation study using the Promoting Action on Research Implementation in Health Services (PARIHS) framework.
- To optimize pain care processes in a tertiary pediatric emergency department.
- To assess the impact of the Kids Pain Collaborative (KPC) on pain management.
Main Methods:
- Hybrid type 3 implementation effectiveness design.
- Collaborative appraisal of context and culture informed two action cycles: nurse-initiated analgesia and family involvement.
- Interrupted time series analysis and emotional touchpoint interviews evaluated implementation impact.
Main Results:
- Sustained improvements in nurse-initiated analgesia and pain assessment rates.
- Shift towards person-centred family involvement in pain care.
- Development of frontline staff leadership for sustained innovation in pain management.
Conclusions:
- The Kids Pain Collaborative fostered a practitioner-led coalition for change in pain care.
- Key principles included collaborative engagement, enabling context, safe reflection spaces, and sustainable practice change.
- A multi-level facilitation model, supported by an embedded researcher, drove sustained improvements.
Aim:
To evaluate the impact of a participatory, action-oriented implementation study, guided by the integrated Promoting Action on Research Implementation in Health Services framework, for optimising pain care processes in a tertiary paediatric emergency department.
Design:
Hybrid type 3 implementation effectiveness.
Methods:
A collaborative appraisal of the context and culture of pain care informed two interdependent action cycles: Enabling nurse-initiated analgesia and involving families in pain care. The Kids Pain Collaborative, an authentic clinical-academic partnership, was central to facilitating successful implementation. Summative evaluation explored the impact of implementation on processes of pain care using an interrupted time series analysis and emotional touchpoint interviews with families.
Results:
Staff achieved clinically important and sustained improvements in the rate of nurse-initiated analgesia and pain assessment. Family involvement in pain care shifted from task-orientated practices towards more person-centred ways of working and decision-making. As capacity for collective leadership developed, frontline staff found ways to integrate the KPC approach into ED systems to lead pain care innovation beyond the life of the research project.
Conclusions:
The Kids Pain Collaborative, as the overarching implementation strategy, created a practitioner-led coalition for change. Successful implementation was facilitated by working with four interdependent principles: Collaborative and authentic engagement; enabling context for cultural transformation; creating safe spaces for critical reflection and workplace learning; and embedding sustainable practice change.
Impact:
A multi-level model of internal-external facilitation enabled sustained improvement in pain care practice. An embedded researcher was pivotal in this process.
Patient Contribution:
Authentic engagement of clinicians and families was pivotal in transforming systems of pain care and enabling a culture where "it is not ok for children to wait in pain" IMPLICATIONS FOR PRACTICE: The principles underpinning the Kids Pain Collaborative are transferable to other emergency department and acute care contexts.
Reporting Method:
Standards for Reporting Implementation Studies checklist.
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