Improving Pain Assessment and Management on Pediatric Medical-Surgical Units

Kimberly Eiden APRN, MS, PCNS-BC

Clinical Nurse Specialist, Pediatric Pain Service

kimberly.eiden@advocatehealth.com

Advocate Hope Children’s Hospital Oak Lawn, Illinois

www.advocatehealth.com/hope

Case Study Highlights

The interprofessional Pediatric Pain and Comfort Team conducted a thorough baseline assessment of staff knowledge and patientS’ and parentS’ satisfaction with pain management, and then addressed the discovered gaps in performance (e.g., standardized age-appropriate assessments, revised pain treatment guidelines, expanded child life therapy services). The pediatric pain advanced practice nurse (APN) hired to lead the pain management program instituted more frequent audits of pain assessment and developed staff education based on audit results.

Identifying the Problem and Exploring Causes

According to the American Academy of Pediatrics (AAP) and the American Pain Society (APS), a substantial percentage of children are undertreated for acute and chronic pain, despite extensive literature that describes how to evaluate and treat pain in children. Personal values and beliefs of healthcare professionals about the meaning and value of pain in the development of a child (for instance, the belief that pain builds character) and about the treatment of pain cannot stand in the way of the optimal recognition and treatment of pain for all children (AAP & APS, 2001). As indicated by the experience of the Wisconsin Pain Initiative, a leading organization in the field of pain management endorsed by the Joint Commission, the establishment of an interprofessional workgroup is the first step in an organization’s commitment to pain management (Gordon, Dahl, & Stevenson, 2000).

In 2005, Advocate Hope Children’s Hospital (see Figure 1) established the Pediatric Pain and Comfort Team. The team recognized the necessity of conducting an institutional needs assessment as its first step in improving pain management. Baseline data were collected from multiple sources:

A survey of staff knowledge and perceptions designed by the team and distributed to physicians, nurses, pharmacists, child life therapists, and ancillary staff.
A survey of patientS’ and parentS’ satisfaction with pain management designed by the team.
Post-discharge data from the Patient Satisfaction Survey question, “How well was your pain controlled?”