scholarly journals Improving the Treatment and Assessment of Moderate and Severe Pain in a Pediatric Emergency Department

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Roger Chafe ◽  
Debbie Harnum ◽  
Robert Porter
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Focus Group ◽  
Severe Pain ◽  
Pain Treatment ◽  
Pediatric Emergency ◽  
Standards Of Care ◽  
Treatment Protocols ◽  
Assessment And Treatment ◽  
The Impact

Background.The Janeway Children’s Hospital previously enacted a number of measures to improve pain management for patients in its emergency department (ED). While improvements were demonstrated, rates for the timely assessment and treatment of pain remain below standards of care.Objectives.The study objectives are to investigate the impact of the previous attempts to improve the treatment of pain and to explore ways to further improve pain management in the ED.Methods.Key informant interviews and a focus group were conducted with nurses, physicians, and parents whose children were identified as having severe pain.Results.Interviews were conducted with 31 parents or children, 9 physicians, and 8 nurses. The focus group was attended by 15 nurses. Previous initiatives were viewed as improvements. Continued barriers include difficulties in accurately capturing the level of pain, issues in treating pain for specific types of patients, and inadequacy in addressing patients in severe pain.Conclusion.Changes in pain treatment protocols can result in positive impacts but are likely insufficient on their own to achieve desired standards of care. Consistent measurement and engagement with staff can identify additional opportunities for improving pain management within an ED setting.

The impact of educational intervention programs on pain management in a pediatric emergency department

2006 ◽  
Vol 60 (7) ◽  
pp. 299-302 ◽  
Author(s):  
Arie Augarten ◽  
Ruth Zaslansky ◽  
Ilan Matok Pharm ◽  
Tal Minuskin ◽  
Liat Lerner-Geva ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Educational Intervention ◽  
Pediatric Emergency ◽  
Intervention Programs ◽  
Pediatric Emergency Department ◽  
The Impact

scholarly journals Understanding the pain status of the patient: a survey of pain status and pain treatment in an orthopedic outpatient department

2014 ◽  
Vol 8 (2) ◽  
pp. 211-219
Author(s):  
Wiwat Wajanavisit ◽  
Pongsthorn Chanplakorn ◽  
Noratep Kulachote ◽  
Puttavee Charoenwanthanang ◽  
Patarawan Woratanarat
Keyword(s):  
Pain Management ◽  
Sleep Disturbance ◽  
Severe Pain ◽  
Pain Treatment ◽  
Outpatient Department ◽  
Sleep Habit ◽  
Patients Satisfaction ◽  
Pain Status ◽  
Nonopioid Analgesics ◽  
The Impact

Abstract Background: Pain assessments help clinicians to evaluate their patients’ symptoms. However, patients’ satisfaction with pain management is difficult to interpret and may mislead the clinician into being satisfied with inadequate pain management. Objective: We described and explored patients’ pain status, patients’ satisfaction with their pain management, the impact of pain on sleep habit and routine activities of daily living (ADLs), and the proportion of patients who had undertreatment of pain in the Orthopaedic Outpatient Department, Ramathibodi Hospital. Methods: A prospective, cross-sectional survey study of pain characteristics and pain management of Orthopaedic outpatients aged over 18 years in the Orthopaedics Department, Ramathibodi Hospital using two parts of a verified questionnaire. Results: In all, 863 patients were studied. Numbers of patients with acute or chronic pain were in similar proportions and mainly diagnosed as nociceptive pain (83.7%). Most of them suffered from moderate or severe pain (42.6% vs. 39.1%). Severity of symptoms was correlated with sleep disturbance and disturbance in ADLs. However, no correlation was revealed between satisfaction with pain management and the intensity of pain and there was also no correlation between satisfaction with pain management and sleep disturbance or disturbance in ADLs. Most commonly prescribed medications were nonsteroidal antiinflammatory drugs (NSAIDs) (58.8%). However, 93.4% of returning patients who suffered from severe pain were still treated with nonopioid analgesics. Conclusion: Patients suffered from moderate to severe pain and had disturbances in their sleep habit and ADLs. Most of them were satisfied with previous pain management, which was usually with nonopioid analgesics including NSAIDs and muscle relaxants. This group included some patients who experienced a high intensity of pain. We recommend clinicians pay more attention to the pain intensity of individual patients and justify appropriate medication by using a step-up approach and multimodal analgesics

scholarly journals Implementing Specialized Vestibular Physiotherapy in An Emergency Department: A Process Evaluation

2021 ◽  
Author(s):  
Kelvin Ip ◽  
Melanie Lloyd ◽  
Allison Luscombe ◽  
Danielle Hitch
Keyword(s):  
Emergency Department ◽  
Process Evaluation ◽  
Implementation Process ◽  
Readiness For Change ◽  
Organizational Readiness For Change ◽  
Assessment And Treatment ◽  
Parihs Framework ◽  
Main Barrier ◽  
Multiple Domains ◽  
The Impact

Abstract Background: Dizziness and vertigo-like symptoms, often caused by common peripheral vestibular disorders such as Benign Paroxysmal Positional Vertigo (BPPV), may have a significant detrimental impact on function and quality of life. The impact of these symptoms often result in Emergency Department (ED) presentations. Evidence based clinical practice guidelines strongly recommend the use of physical assessment and treatment maneuvers for the assessment, diagnosis and treatment of these symptoms. The aim of this study was to evaluate the process of implementing specialized vestibular physiotherapy in an emergency department, from the clinician perspective.Methods: This implementation study utilized a retrospective mixed methods process evaluation to understand how specialized vestibular physiotherapy operated in an Australian emergency department. The PARiHS Framework was embedded within the methodology and analytical approach of the study, to ensure a comprehensive approach which was closely aligned to implementation science. Nine clinicians retrospectively completed the Organizational Readiness for Change Assessment (ORCA), Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Seven clinicians also participate in a focus group or interview.Results: A range of barriers and facilitators to the implementation process were identified by participants, some of which spanned multiple domains of the PARiHS framework. Relationships with service leaders, champions and medical staff were found to be a key facilitator to implementation, along with a generally held perception that specialized vestibular physiotherapy was acceptable and feasible. The main barrier identified was a lack of capacity to deliver and support this innovation, both within the physiotherapy workforce and the broader multidisciplinary team.Conclusions: This study demonstrates the process of implementation of a specialized vestibular physiotherapy team in an ED setting was generally well received by clinicians, but also involved some challenges and barriers. Services looking to implement specialized vestibular physiotherapy in the ED may refer to the recommendations arising from the findings of this study to guide their approach to innovation.

scholarly journals Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Matthew J Molloy ◽  
Wendy Shields ◽  
Molly W Stevens ◽  
Andrea C Gielen
Keyword(s):  
Emergency Department ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Short Term ◽  
Minor Injury ◽  
Minor Injuries ◽  
A Minor ◽  
The Impact ◽  
At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Optimizing Pain Management For Children With Sickle Cell Disease Vaso-occlusive Crisis In The Pediatric Emergency Department

2021 ◽  
Author(s):  
Wilson Andres Vasconez ◽  
Claudia Aguilar-Velez ◽  
Cristina Matheus ◽  
Hector Chavez ◽  
Roxana Middleton-Garcia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Cell Disease

scholarly journals 77 MANAGEMENT OF PEDIATRIC POST-CONCUSSIVE HEADACHES: A NATIONAL SURVEY OF ABORTIVE THERAPIES USED IN THE EMERGENCY DEPARTMENT

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e32-e32
Author(s):  
Kristen Lambrinakos-Raymond ◽  
Brett Burstein ◽  
Isabelle Gagnon ◽  
Roger Zemek ◽  
Alexander Sasha Dubrovsky
Keyword(s):  
Emergency Department ◽  
Severe Pain ◽  
Treatment Strategies ◽  
Pediatric Emergency ◽  
Future Research ◽  
Patient Reporting ◽  
Post Injury ◽  
Duration Of Symptoms ◽  
Headache Intensity ◽  
Refractory Pain

Abstract Background The incidence of children presenting to an Emergency Department (ED) following concussion has increased markedly in recent decades. Headache is the most commonly associated symptom and recent guidelines emphasize the importance of analgesia, yet evidence to inform treatment of post-concussive headache (PCH) is completely lacking. Objectives This study sought to characterize abortive therapies used to treat PCH among physicians in academic pediatric EDs and to determine whether duration of symptoms and/or headache intensity influence treatment strategies. Design/Methods A scenario-based electronic survey was sent to physician members of the Pediatric Emergency Research Canada (PERC) database. Participants were asked questions regarding management when presented with cases of an adolescent presenting to the ED with PCH refractory to appropriate doses of acetaminophen and ibuprofen. Scenarios differed only by duration of symptoms (48-hours versus 1-month post-injury), as well as headache intensity (moderate versus severe). Descriptive statistics are reported. Results Survey response rate was 63% (n/N=137/219). At 48 hours post-injury, 93% of physicians reported that they would initiate treatment for a headache rated as severe. The most commonly selected medications to treat PCH were metoclopramide (72%), an intravenous bolus of normal saline (47%) and non-steroidal anti-inflammatories (NSAIDS; 35%). There was wide variability among second line strategies for refractory pain following first-line treatment. When presented with PTH pain rated moderate in severity, 63% of respondents would change their management compared to severe pain, with 66% no longer offering pharmacologic treatment in the ED and most frequently selecting oral NSAIDS (58%) when electing to initiate treatment. Medication selection was unchanged when presented with a patient reporting severe PCH at 1 month compared to 48-hours post-injury. Conclusion Most physicians would treat pediatric PCH in the ED for a patient reporting severe pain, however, pain rated as moderate was less likely to receive abortive treatment. Metoclopramide was the most frequently selected medication for analgesia for severe pain. Future research should aim to establish the efficacy of this and comparative treatments for PTH in children.

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