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Copy of Pain Managment in Children
Transcript of Copy of Pain Managment in Children
Dr. Jan Seeley
Lakehead University and Confederation College
October 20, 2011 Objectives - State the purpose of the RNAO Best Practice Guidelines (BPG) regarding pain management in children
- Definition of the term pain management
- Identify Signs and symptoms of pain in children
- Examine risk factors associated with pain medication and children
- Examine practice recommendations for pain management in children
- Examine Educational recommendations for pain management in children
- Examine literature review of pain management in children
(prevalence of pain in children) The purpose of the guidelines is to develop statements to assist practitioners’ and clients’ decisions about appropriate health care. This best practice guideline is intended to provide direction to practicing nurses in all care settings, both institutional and community, in the assessment and management of pain, including prevention of pain wherever possible.
The guideline incorporates best practices across the setting of both acute and chronic pain with specific recommendations re: specialized populations such as children. Nurses working in specialty areas such as pediatrics, will require further practice direction
from clinical practice guidelines in their unique area of focus (RNAO, 2007). Purpose and Scope Definition of Pain Managment The process of providing medical care that alleviates or reduces pain. Encompasses pharmacological, nonpharmacological, and other approaches to prevent, reduce, or stop pain sensations. Signs and Symptoms of Pain in Children In Children:
- activity level
- vital signs
(CNOA, 2007) Liturature Review
Prevelence of Pain in Children Risk Factors Associated with Pain Management use in Children Gastric emptying is slower in infants less than 6 months of age therefore the absorption of some drugs will be increased (Cunliffe Mary & Roberts Stephens, 2004). Children have lower levels of alpha-1 acid glycoprotein, which is the main drug binding protein, which means for a given dose of drug, more will be present in the free form, giving it a greater effect (Cunliffe Mary & Roberts Stephens, 2004). Children have less fat and muscle as a percentage of body weight (Cunliffe Mary & Roberts Stephens, 2004). Children have an immature liver which means that all its metabolic processes are slower resulting in a lower clearance and a prolonged half-life for many drugs (Cunliffe Mary & Roberts Stephens, 2004). Practice Recommendation Assessment
Screening for pain
- Young children have difficulty describing and expressing pain. A nurse needs to adapt approaches for assessing a child's pain (including what to ask and the behaviours to observe for) and how to prepare a child for a painful precedure (Potter, Patricia, Perry, Anne, Ross-Kerr, Janet & Wood, Marilynn, 2006).
- Ask parents the words a child might use to describe pain or observe (ex hurt, boo boo) the child for signs/behaviors indicative of pain (RNOA, 2007).
- A nurse should screen for pain when undertaking other routine assessments (RNOA, 2007).
Pain Assessment Tools used for Children
- Premature Infant Pain Profile (PIPP)
- Neonatal Infant Pain Scale (NIPS)
- Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS)
- Wong-Baker Faces Scale
(RNOA, 2007) Examples of Pain Assessment Tools Wong-Baker Faces Scale Premature Infant Pain Profile (PIPP) Educational Recomendations "Educational programs must provide opportunities for the nurse to demonstrate effective practices in pain assessment and management, and must address the resources necessary to support practice (eg. practice modifications, reminder systems, removal of barriers, etc.)"(RNOA, 2007). "Educational programs should be designed to facilitate change in nurses’ knowledge, skills, attitudes and beliefs about pain assessment and management in order to ensure support for new practices" (RNOA, 2007). Nurses entering the working field must have knowledge of the principles of pain assessment and management
"The principles of pain assessment and management should be included in orientation programs and be made available through professional development opportunities in the organization"(RNOA, 2007). The following is information from a study of pain in hospitalized patients at the Hospital for Sick Children (Toronto, Ontario).
The Hospital for Sick Children in Toronto holds 300 beds, like many North
American academic pediatric hospitals they provide an advanced practice nurse-run acute pain service (APS), to provide proper pain managment for children, although only 5% of inpatients will access this service during their hospital stay. So the majority of pain management is assessed and managed by the patient’s primary medical/surgical and nursing teams (Taylor Elsa, Boyer Kristina & Campbell Fiona, 2008).
"In 2003, a Picker Patient Satisfaction survey of discharged patients from this hospital
suggested that inpatients were receiving suboptimal pain management, reflecting what has also been shown in the few available studies done at other centres" (Taylor Elsa, Boyer Kristina & Campbell Fiona, 2008).
The Hospital Executives decided to further explore whether the retrospective patient satisfaction
results held true by performing interviews with 241 inpatients at the Hospital for Sick Children (Taylor Elsa, Boyer Kristina & Campbell Fiona, 2008) .
The results are as follows... had some pain during admission 77 % had moderate or severe
pain at some time in the previous 24 h 64 % of patients were pain free at the time of
interview 49 % had been pain free
in the preceding 24 h 15 % When the patients who had experienced pain during admission...
thought that they had received no pain medicine in the preceding 24 h.
of the children who had experienced pain during
admission had received no analgesia,
had received it intermittently
had received regular analgesia 44% 42% 33% 25% "We found that pain occurred commonly across all age groups and services. Pain was infrequently assessed. Analgesic therapy was largely single agent and intermittent, although very helpful when given" (Taylor Elsa, Boyer Kristina & Campbell Fiona, 2008).
"The present audit has been, and remains, a very useful tool to initiate change across our hospital" (Taylor Elsa, Boyer Kristina & Campbell Fiona, 2008). Study Conclusion Teaching Tool For Children to Watch Before a Surgery References
Potter Patricia, A., Perry Anne, G., Ross-Kerr Janet, C., & Wood Marilynn, J. (2006). Canadian fundamentals of nursing. (3 ed., p. 1243). Toronto, Ontario, Canada: Elsevier Canada.
Cunliffe Mary. , & Roberts Stephens, A. (2004). Pain management in children. 5. Retrieved from http://utenti.unife.it/giampaolo.garani/Sedazione-Farmaci/Articoli Dolore/Pain management in children11-04.pdf
Taylor Elsa, M., Boyer Kristina, , & Campbell Fiona, A. (2008). Pain in hospitalized children: a prospective crosssectional. 1-8. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670807/pdf/prm13025.pdf
Registered Nurses’ Association of Ontario (2007). Assessment and Managment of Painp. Retrieved from: http://www.rnao.org/Storage/29/2351_BPG_Pain_and_Supp.pdf (Taylor Elsa, Boyer Kristina & Campbell Fiona, 2008) Any Questions?