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An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Swedish Nurses Pain Assessment Documentation of Children in the Perioperative Period
Emma Westin1,2,3, Angelica Wiljén4,5,6, Johanna Hagman7,8
1Department of Health and Caring Sciences Linnaeus University Faculty of Health and Life Sciences Växjö Sweden.
Insights
Pediatric surgical patients often lack consistent pain scale documentation, despite guidelines. While pain narratives are common, formal pain scale use varies, indicating national guidelines for pain assessment are not fully followed.
Area of Science:
- Pediatric Surgery
- Pain Management
- Healthcare Quality Improvement
Background:
- Pain is prevalent in pediatric surgical patients, necessitating appropriate assessment.
- Current research highlights deficits in pain assessment and documentation for children.
- Adherence to pain assessment guidelines is crucial for effective pediatric pain management.
Purpose of the Study:
- To evaluate the frequency and nature of pain assessment documentation in pediatric surgical patients.
- To analyze pain intensity scoring and pain narrative documentation across the perioperative period.
- To identify gaps in adherence to national pain assessment guidelines in a Swedish healthcare setting.
Main Methods:
- Quantitative descriptive retrospective review of 114 medical records of children (7-17 years) undergoing surgery.
- Data collection included demographic information, surgery type, and pain assessment documentation (pain scales, pain narratives, pain intensity scores).
- Descriptive and inferential statistical analyses were employed to examine the data.
Main Results:
- Pain scales were documented for 78.8% of patients, most frequently in the recovery unit (63.8% of assessments).
- Pain narratives were present in 99.1% of records, predominantly documented postoperatively on the pediatric ward (69.6%).
- Moderate to severe pain was reported in 38.6% of pain scale ratings, with significant variations in documented pain scale use between hospitals and time periods.
Conclusions:
- While all pediatric surgical patients had some form of pain assessment documented, not all received a formal pain scale assessment.
- Pain scale documentation was highest in the recovery unit, contrasting with the prevalence of pain narratives on the pediatric ward.
- The findings suggest that national guidelines for comprehensive pain assessment in pediatric surgical patients are not consistently followed throughout the entire hospital stay.
Abstract:
In healthcare, pain is common in children, with a higher risk of pain in children admitted for surgery. According to guidelines, pain should be assessed with a pain scale suitable to the age and maturity of the child to be able to provide the right treatment. However, research indicates shortages in assessment and documentation regarding children's pain. The aim of the current study was to describe the frequency and nature of pain assessment documentation, including pain intensity scoring, in surgical patients across the perioperative period. We performed a quantitative descriptive retrospective review of medical records at two county hospitals in the south of Sweden. In all, 114 children 7-17 years of age admitted to one of the hospitals in connection to surgery were included. Demographic and clinical data such as age, sex, type of surgery, and documentation regarding pain were collected from the medical records according to a predetermined protocol including the number and type of pain assessments and pain intensity scores. Data were analyzed with descriptive and inferential statistics. The findings show that pain scales were used and documented in 89 children (78.8%) once or more during the stay, and 155 (63.8%) of these assessments were performed in the recovery unit. One or more pain narratives were found in 113 (99.1%) of the medical records, of which 350 (69.6%) were written postoperative on the pediatric ward. There was a significant difference in the number of children who had at least one documented pain scale assessment, both between the hospitals and between the different time periods within the hospitals (preoperative on ward, recovery unit and postoperative on ward), but not between age groups. Moderate to severe pain was reported in 38.6% of the pain scale ratings. In conclusion, all the children had some kind of documented assessment of pain during their hospital stay, but not all children had a documented pain scale assessment. Documented pain scale assessments were most common in the recovery unit, whereas pain narratives were most common on the pediatric ward after the surgery. Looking at the entire length of the hospital stay, the result indicates that national guidelines for pain assessment are not being followed.
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