Measuring Improvement in Children's Pain: Modification of Pediatric Pain Measure to Capture pain Reduction

Purpose:
Aim 1-to develop and test method for demonstrating pain reduction for hospitalized children using the NDNQI pain assessment-intervention-reassessment cycle measure. Aim 2-to determine whether, using this measure, hospitalized children had documented reductions in pain during the pain AIR cycle.

Background/Significance:
Literature describes that children do not get appropriate pain management, due to many factors. Goal to capture valid pain measurement before and after intervention to improve upon pain reduction for hospitalized children. Wanted to use existing pediatric Pain AIR cycle measure to capture pain scores, at first and subsequent reassessment after intervention. Modifying exisitng measure meant that nurses were already familiar with it, and had demonstrated success with completing pain AIR cycles.

Methods:
Collected retrospective chart data from multiple pediatric units in four children's hospitals using modification of the pediatric pain AIR measure. Pain scores from 101 children between ages of 3-18 years were analyzed. 41 children had positive pain scores during one or more AIR cycle. Collected and analyzed data, including age, gender, unit type, and pain data for two sequential pain AIR cycles. Analyzed appropriateness of pain scales used, actual pain scale scores, pain type, interventions used, and times of assessment and reassessment. Calculated percent reductions in pain and pain experience of children with pain scores >0 and pain scores >3.

Results:
Determined that modified pain AIR cycle measure was useful to evaluate reductions in pain scores for children; that nearly 70% of children in pain received pharmacologic intervention but that only 60% of those received pain relief; that while meta-analyzses of pain scale literature provides useful guidance for the use of certain pain scales, depending upon age and type of pain, that nurses frequently did not use the most valid scale; that preschool children whose pain was scored by nurses had greater or more frequent pain relief than adolescent children, who determined their own pain score; and that no standard was applied to time to reassessment after intervention-ranged from 30 min-4 hrs.

Conclusions and Implications for Practice:
Practice implications-nurses need education about valid and reliable pain scales; education regarding non-pharmacologic interventions is important; that standards for time to reassessment of pain after intervention is ineffective and institutional policies are not applied effectively.