Improving Pediatric Pain Management Practice

Purpose:
Improving pediatric pain assessment and documentation by focusing on clinical care, patient safety and complete documentation was targeted following review of quarterly NDNQI pain data indicating areas for improvement.

Significance:
Quality pain management is a significant nursing responsibility. Pediatric nurses need to use a variety of developmentally appropriate pain assessment techniques when providing care. Complete documentation of care impacts communication about and continuity of effective pain management.

Strategy and Implementation:
A combination of hospital wide efforts and unique unit based strategies were initiated over a 3yr period. Hospital wide efforts included the development of a pain resource nurse (PRN) program with unit based champions that meets monthly to discuss pain management challenges, share best practice, critique literature and identify projects to improve practice.Revisions to the nursing documentation Patient Care Flow Sheet were made to link pain management data in one area for a more logical flow of information and add coded lists of common pain interventions.Unit specific efforts included chart audits with direct, individual coaching to nurses at point of care. Discussions occurred as the pain management policy was modified to include a pain assessment tool specific to the vulnerable population of children with cognitive impairment.Weekly interdisciplinary rounds were conducted to discuss clinical care strategies and specific pain management strategies e.g. planned complex dressing changes

Evaluation:
The PRN program, modification of pain documentation and unit specific efforts have been instrumental in improving pain management.Success has been measured by sustained improvement in 2009 quarterly NDNQI reported AIR cycles and an increase in the number of pain assessments initiated in 24 hours/pt.

Implications for Practice:
Putting in place systems, both unit and hospital wide, that allow for intermittent practice review, monthly evidence updates and ongoing interdisciplinary discussion about clinical pain issues as they relate to patient care is key to improvement.