Trainee Advanced Paediatric Nurse Practitioner
Place of work
Paediatric Emergency Department, East Lancashire Hospitals NHS Trust
Pain is subjective and children often do not have the cognitive development, language development or maturity to articulate the severity of their pain. The Royal College of Emergency Medicine (2013) recommend the use of the following:
- A multi age and cognition pain assessment tool
- Guidelines for choice of appropriate analgesia
- Reassessment within 60 minutes of administered analgesia
A retrospective audit of 29 children with suspected fractures was undertaken in the Paediatric Emergency Department and highlighted poor pain assessment as part of the triage process. A Staff training analysis demonstrated poor staff knowledge and little confidence in paediatric pain assessment.
Research suggests inadequately managed pain can create a poor experience for the child and their family and can lead to long term psychological difficulties, chronic pain conditions and a negative experience for the child.
To ensure children attending the Emergency Department with limb injuries have their pain effectively assessed at the point of triage, appropriate analgesia administered and reassessment within 60 minutes of administration by appropriately trained staff through the use of bundle.
Using Kotter’s ‘8 step change model’ to guide the implementation of a paediatric pain assessment bundle.
- Key stakeholders identified and fully engaged
- Bundle peer reviewed
- Take home leaflet for managing children’s pain at home
- Department and trust governance approval granted for pilot.
- Staff training on Pain assessment through micro teaching and teaching packs
- Online Entonox training from gas supplier introduced
- Diclofenac availability approval by pharmacy
- Ensuring all PGD’s current and completed by staff
Continual evaluation will be carried out and a re-audit measured against the same standards (RCEM, 2013). The audit examined if pain assessment was completed at first point of triage, appropriate analgesia administered based on pain score and re-assessment within 60 minutes of administration of analgesia. A staff training questionnaire measured staff knowledge and confidence with patient feedback obtained through friends and family cards.
The Paediatric pain assessment bundle ensures children visiting the Emergency Department are being cared for efficiently and receiving optimum care. Children often attend hospital with a primary complaint of pain.
This change in practice will safeguard and ensure children are having their pain effectively managed, reassessed and advised how to manage at home by well trained and competent staff, thus creating a positive hospital experience for the child.
Three key learning points
1. Engaging stakeholders early in the change process is essential to the success of the change
2. An approved pain assessment bundle will reduce mismanagement of pain in children and eradicate uncertainties in choice of analgesia, sustainability is dependent on keeping the topic current
3. Identifying ‘champions’ early in the change process enables continuity and assurance staff remain motivated