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Aims Lumbar puncture (LP) is a common procedure in children used to diagnose infection and various neurologic processes. We want to survey current clinical practises, in terms of positioning and use of analgesia, in paediatric LPs. Methods A survey questionnaire was designed for distribution to staff on the wards of 10 paediatric departments in one city. The survey contained questions about demographics, choice of position during LPs, reasons for that choice, use and frequency of analgesia, LP training background and demand for training. Questions about positions and pain relief were divided into different age groups. Results A total of 84 questionnaires were completed, which demonstrated that the most common position being used in children under the age of 1 was the lateral recumbent position with neck flexion (83% in newborns to 3 months and 59% in 3 months to 1 year). 61% of participants said this position was used to increase the interspinous distance, whilst 27% said is was used to best hold the child still. Sucrose was the most commonly used for of pain relief in children under one, however 39% of participants never, rarely or only sometimes used pain relief in this age group. 79% of participants would appreciate more training in this area. Conclusion We demonstrated that a painful, uncomfortable and potentially dangerous position to hold children during LPs was the first choice in the majority of cases. We also demonstrated that the use of analgesia in general was either absent or poor. Further education of healthcare staff involved in this procedure is needed.

BackgroundThe NHS is facing unprecedented pressure to provide care with an ever decreasing budget. Inspired by the Choosing wisely initiative and a recent document by the Academy of Medical Royal Colleges, which have documented positive changes in improving patient care by highlighting areas of overdiagnosis and overtreatment.MethodsA workgroup of junior and middle grade doctors and an operational manager identified common presentations to the paediatric ED. Seven presentations were chosen and the most common diagnostic tests ordered listed, which were compared to national guidelines. The cost of all of the tests were sought and the difference calculated.ResultsThe chosen presentations to the paediatric ED with proposed changes are: pneumonia, bronchiolitis, gastroenteritis, cellulitis, asthma, febrile convulsions and ankle/knee injuries. Spot check initial results showed significant potential cost savings without compromising best patient centred care. There would also have been a significant reduction in potential pain and discomfort to the patient and a reduction in unnecessary radiation exposure.ConclusionsBetter patient care can be achieved by following national guidelines more strictly, with the added benefits of less waste and cost savings. We have calculated as a conservative estimate, that if our department reduced only 30% of the identified unnecessary tests, a saving of £20,000 per annum could be achieved.

Background and aims Provision of analgesia for painful needle procedures in children is still often inadequate despite national and international evidence-based guidelines. Untreated pain has negative consequences for children both physically and emotionally. Parental anxiety regarding procedural pain experienced by their children and the need for more information is also well documented in the literature. We aim to survey attitudes of paediatric staff on educating parents about analgesia options for needle procedures and knowledge of negative consequences caused by painful procedures performed without analgesia. Method Randomly selected paediatric doctors and nurses in various paediatric departments were shown either a video podcast or youtube clip, which were created as educational tools for parents to provide them with information on analgesia options for painful needle procedures, and then asked to complete questionnaires. The video podcast and/or youtube clip were shown on mobile devices. Results A total of 86 questionnaire were completed. 43–52% agreed (38–45% strongly agreed) that parents should be educated on pain management for needle procedures and that it is an important issue. 54% agreed (28% strongly agreed) that educating parents will improve care for children. 55% were never asked by parents about analgesia. GPs and Hospitals as providers for information were mentioned most frequently. Posters and pamphlets were thought to be ideal means to inform parents. The level of ‘full knowledge’ about analgesia management options among paediatric doctors and nurses increased from 44% to 70% after watching the video podcast and/or youtube clip. 30% ticked neutral, 14% unlikely and 9% unlikely that untreated pain can lead to the development of needle phobia. 25% ticked neutral, 20% unlikely and 5% very unlikely that it can lead to immunisation non-compliance. Conclusion We demonstrated that paediatric staff have an overwhelmingly positive attitude to introduce parent education on how to make needle procedures a less painful experience for children. A significant proportion of surveyed paediatric staff, however, seem unaware that untreated pain can have significant negative consequences for the wellbeing of children. The burden of pain and its consequences on children and their families has to be reduced by continuing to educate healthcare staff combined with educating parents.