A Quality Improvement Project on Pain Management at a Tertiary Pediatric Hospital

2021 ◽  
pp. 084456212110477
Author(s):  
Jodi Wilding ◽  
Hailey Scott ◽  
Victoria Suwalska ◽  
Zarina Geddes ◽  
Carolina Lavin Venegas ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Management ◽  
Chart Review ◽  
Management Practices ◽  
Pain Treatment ◽  
Management Strategies ◽  
Improvement Project ◽  
Pain Scores ◽  
Health Quality ◽  
T1 And T2

To assess and improve pain management practices for hospitalized children in an urban tertiary pediatric teaching hospital. Methods Health Quality Ontario Quality Improvement (QI) framework informed this study. A pre (T1) – post (T2) intervention assessment included chart reviews and children/caregiver surveys to ascertain pain management practices. Information on self-reported pain intensity, painful procedures, pain treatment and satisfaction were obtained from children/caregivers. Documented pain assessment, pain scores, and pharmacological/non-pharmacological pain treatments were collected by chart review. T1 data was fed back to pediatric units to inform their decisions and pain management targets. Results At T1, 51 (58% of eligible participants) children/caregivers participated. At T2, 86 (97%) chart reviews and 51 (54%) children/caregivers surveys were completed. Most children/caregivers at T1 (78%) and T2 (80%) reported moderate to severe pain during their hospitalization. A mean of 2.6 painful procedures were documented in the previous 24 h, with the most common being needle-related procedures at both T1 and T2. Pain management strategies were infrequently used during needle-related procedures at both time points. Conclusion No improvements in pain management as measured by the T1 and T2 data occurred. Findings informed further pain management initiatives in the participating hospital.

scholarly journals Pain Prevalence in a Pediatric Hospital: Raising Awareness during Pain Awareness Week

2014 ◽  
Vol 19 (1) ◽  
pp. e24-e30 ◽  
Author(s):  
Denise Harrison ◽  
Cynthia Joly ◽  
Christine Chretien ◽  
Sarah Cochrane ◽  
Jacqueline Ellis ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Assessment ◽  
Management Practices ◽  
Management Strategies ◽  
Cross Sectional Study ◽  
Infants And Children ◽  
Assessment Tools ◽  
Pediatric Hospital ◽  
Cross Sectional ◽  
Pain Scores

BACKGROUND: Despite the evidence and availability of numerous validated pain assessment tools and pain management strategies for infants and children, their use remains inconsistent in clinical practice.OBJECTIVES: To describe the prevalence of pain, pain assessment and pain management practices at a tertiary pediatric hospital in Canada.METHODS: The cross-sectional study design involved a combination of interviews with children and/or caregivers, and chart audits in five inpatient units. Information regarding pain intensity, painful procedures and pain management strategies was obtained from children and/or caregivers by interview. Patient charts were reviewed for information regarding pain assessment, pain scores, and pharmacological and nonpharmacological interventions.RESULTS: Sixty-two children (four days to 17 years of age) participated. Most children or their caregivers (n=51 [84%]) reported that pain was experienced during their hospitalization, with 40 (66%) reporting their worst pain as moderate or severe. Almost one-half reported analgesics were administered before or during their most recent painful procedure. Nineteen (32%) reported sucrose, topical anesthetics or nonpharmacological interventions were used; however, they were documented in only 17% of charts. Pain scores were documented in 34 (55%) charts in the previous 24 h. The majority of the children or their caregiver (n=44 [71%]) were satisfied with pain management at the study hospital.CONCLUSIONS: Most infants and children had experienced moderate or severe pain during their hospitalization. Analgesics were frequently used, and although nonpharmacological strategies were reported to be used, they were rarely documented. Most parents and children were satisfied with their pain management.

scholarly journals An Interprofessional Approach to Chronic Pain Management and Education

2022 ◽  
Vol 54 (1) ◽  
pp. 47-53
Author(s):  
Nida S. Awadallah ◽  
Vanessa Rollins ◽  
Alvin B. Oung ◽  
Miriam Dickinson ◽  
Dionisia de la Cerda ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Chart Review ◽  
Pain Treatment ◽  
Retrospective Chart Review ◽  
Training Methods ◽  
Chronic Pain Management ◽  
Training Experience ◽  
Community Based ◽  
Pain Scores

Background and Objectives: The opioid epidemic highlights the importance of evidence-based practices in the management of chronic pain and the need for improved resident education focused on chronic pain treatment and controlled substance use. We present the development, implementation, and outcomes of a novel, long-standing interprofessional safe prescribing committee (SPC) and resulting policy, protocol, and longitudinal curriculum to address patient care and educational gaps in chronic pain management for residents in training. Methods: The SPC developed and implemented an opioid prescribing policy, protocol, and longitudinal curriculum in a single, community-based residency program. We conducted a postcurriculum survey for resident graduates to assess impact of knowledge gained. We conducted a retrospective chart review for patients on chronic opioid therapy to assess change in morphine equivalent dosing (MED) and pain scores pre- and postintervention. Results: A postcurriculum survey was completed by 20/26 (77%) graduates; 18/20 (90%) felt well-equipped to manage chronic pain based on their residency training experience. We completed a retrospective chart review on 57 patients. We found a significant decrease in MED (-20.34 [SE 5.12], P<.0001) at intervention visit with MED reductions maintained through the postintervention period (-9.43 per year additional decrease [SE 5.25], P=.073). We observed improvement in postintervention pain scores (P=.017). Conclusions: Our study illustrates the effectiveness of an interprofessional committee in lowering prescribed opioid doses and enhancing chronic pain education in a community-based residency setting.

Embedded palliative medicine model for inpatient solid tumor oncology patients utilizing corounding and consultation criteria: A quality improvement pilot.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 148-148
Author(s):  
Susan McInnes ◽  
Bassam N. Estfan ◽  
Alberto J. Montero
Keyword(s):  
Quality Improvement ◽  
Pain Management ◽  
Solid Tumor ◽  
Healthcare Providers ◽  
Cleveland Clinic ◽  
Unplanned Readmission ◽  
Consult Service ◽  
Improvement Project ◽  
Pain Scores ◽  
The Impact

148 Background: Hospitalized patients (pts) on solid tumor oncology (STO) services have palliative needs including pain management. This quality improvement project sought to establish a new STO-specific co-rounding PM consult service, evaluate the use of consult criteria for STO inpatients, assess the impact/interest in an embedded service, improve access to PM for STO pts and improve palliative education to STO teams. Methods: During October 2015 to January 2016, a new PM consult service was established for the 2 STO inpatient services at Cleveland Clinic. The PM attending physician (MD) rounded with each of the STO teams twice a week. On weekdays, the PM MD chart-screened all STO pts for palliative needs such as uncontrolled pain (2 pain scores ≥ 6 out of 10 in 24 hours), unplanned readmission within 30 days or contact with a PM MD as an outpatient. Other PM needs were assessed on rounds. PM consults were offered for pts who screened positive and were performed if approved by the STO team. STO MDs were surveyed anonymously regarding acceptance of the embedded service. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data regarding pain management during the pilot period was reviewed. Results: Average daily census for the 2 STO teams was 28 pts. There were 282 positive palliative screens in 4 months, 119 of whom were seen in consultation (42%.) The embedded service saw 42-45 new consults per month. The PM team followed 22-35% of all STO inpatients. 14-18 pts/month new to PM were referred to the outpatient PM clinic after discharge. STO MDs indicated strong acceptance of the embedded PM team for pain management, STO team education and coordination of care. All STO MDs wanted the service to continue. HCAHPS pain scores for the entire STO floor improved from a baseline 39th percentile to 98thpercentile. Conclusions: PM was integrated successfully into daily hospital care of STO pts at our institution using a co-rounding model and consult criteria. The service was busy and well received by STO MDs. Continuity with outpatient PM was provided. HCAHPS pain scores improved for the entire STO floor, including pts not directly seen by PM.

scholarly journals Enhancing Pain Management in the PICU by Teaching Guided Mental Imagery: A Quality-Improvement Project

2009 ◽  
Vol 35 (1) ◽  
pp. 25-31 ◽  
Author(s):  
William H Kline ◽  
Ayme Turnbull ◽  
Victor E Labruna ◽  
Laurie Haufler ◽  
Susan DeVivio ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Management ◽  
Mental Imagery ◽  
Quality Improvement Project ◽  
Improvement Project

scholarly journals Pain in the Prehospital Setting in Rwanda: Results of a Mixed-Methods Quality Improvement Project

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
A. Rosenberg ◽  
E. Uwitonze ◽  
M. Dworkin ◽  
J. P. D. Guidry ◽  
T. Cyuzuzo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pain Management ◽  
Prehospital Setting ◽  
Quality Improvement Project ◽  
Ambulance Service ◽  
Theory Approach ◽  
Improvement Project ◽  
Pain Medications ◽  
Context Specific ◽  
Numeric Scale

Introduction. Pain is a universal human experience tied to an individual’s health but difficult to understand. It is especially important in health emergencies. We performed a two-step quality improvement project to assess pain management by the SAMU ambulance service in Kigali, Rwanda, examining how pain is assessed and treated by ambulance staff to facilitate development of standardized guidelines of pain management in the prehospital setting, which did not exist at the time of the study. Materials and Methods. Deidentified ambulance service records from December 2012 to May 2016 were analyzed descriptively for patient demographics, emergency conditions, pain assessment, and medications given. Then, anonymized, semistructured interviews of ambulance staff were conducted until thematic saturation was achieved. Data were analyzed using a grounded theory approach. Results. SAMU managed 11,161 patients over the study period, of which 6,168 (55%) were documented as reporting pain and 5,010 (45%) received pain medications. Men had greater odds of receiving pain medications compared to women (OR = 3.8, 95% CI (3.5, 4.1), p < 0.01). Twenty interviews were conducted with SAMU staff. They indicated that patients communicate pain in different ways. They reported using informal ways to measure pain or a standardized granular numeric scale. The SAMU team reviewed these results and developed plans to modify practices. Conclusions. We reviewed the existing quality of pain management in the prehospital setting in Kigali, Rwanda, assessed the SAMU staff’s perceptions of pain, and facilitated standardization of prehospital pain management through context-specific guidelines.

scholarly journals P.045 Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibody Testing in Calgary: A Quality Improvement Review

2021 ◽  
Vol 48 (s3) ◽  
pp. S32-S32
Author(s):  
JD Krett ◽  
H Hou ◽  
K Alikhani ◽  
MJ Fritzler ◽  
JM Burton
Keyword(s):  
Quality Improvement ◽  
Mayo Clinic ◽  
Chart Review ◽  
False Negative ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Aquaporin 4 ◽  
Antibody Testing ◽  
Improvement Project ◽  
Confirmatory Testing ◽  
Mog Antibodies

Background: Despite the availability of cell-based assays for aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies provincially, outside confirmatory testing is often performed (typically Mayo Clinic Laboratories, USA) when results deviate from expected. It is unknown how often this costly undertaking (upwards of $1,200 CAN) alters diagnosis and management. Methods: We undertook a quality improvement project evaluating the concordance/discordance rate with select chart review in all patients who had cell-based AQP4 or MOG IgG antibody testing at Mitogen Diagnostics (MitogenDx; Calgary, Alberta) and subsequent testing at Mayo Clinic Laboratories from as early as 2010 to July 2020. Results: Preliminary review of data from January 2016 to July 2020 retrieved 145 paired tests; 10 of which were discordant (concordance rate: 93.1%). Chart review confirmed 9 truly discordant cases, often associated with AQP4 or MOG weak-positive results (7/9 cases) or presumed false negative AQP4 results in prototypical neuromyelitis optica spectrum disorder (2/9 cases). Conclusions: Discordant results were rare when comparing MitogenDx local AQP4/MOG antibody test results to those referred out to Mayo Clinic Laboratories, impacting diagnosis and treatment in only 3 patients out of the total. Our results suggest costly outside confirmatory testing of AQP4/MOG antibodies could be reduced.

scholarly journals Quality improvement initiative for pain management practices in primary care

2020 ◽  
Vol 33 (4) ◽  
pp. 513-519
Author(s):  
Judy Embry ◽  
Michael D. Reis ◽  
Glen Couchman ◽  
T. Glenn Ledbetter ◽  
Kiumars Zolfaghari
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Pain Management ◽  
Management Practices ◽  
Quality Improvement Initiative
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