Factors Affecting Emergency Department Assessment and Management of Pain in Children

Abstract

Disparity exists between perceived and documented emergency department pain management practices for children. Quality improvement initiatives should focus on improving pain assessment in infants, treating moderate to severe pain in children of all age groups, and education of health care providers in pain management strategies. Resources should target health care processes effective in decreasing pediatric pain.

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

“…Patient volume, workload, and competing priorities have been reported to be contributing factors (Byrne & Heyman, 1997;Ellis et al, 2007;Olive, 2003;Probst et al, 2005;Puls-McColl et al, 2001;Smith & Feied, 1999) to the under management of pain. Byrne and Heyman (1997) reported that nurses felt it was more important to move patients through the emergency department.…”

“…Previous studies on pediatric pain assessment in the ED setting have primarily measured acute pain as a chief complaint (Alexander & Manno, 2003;Chisholm et al, 2008;Crocker, Higginbotham, King, Taylor, & Milling, 2011;Fry et al, 1999;Garra et al, 2009;Gourde & Damian, 2012;Johnston et al, 1998;Kelly, Powell, & Williams, 2002;Maciocia et al, 2003;McConahay, Bryson, & Bulloch, 2006;O'Donnell, Ferguson, & Bettie, 2002;Probst et al, 2005;Rajasagaram, Taylor, Braitberg, Pearsell, & Capp, 2009;Russo, 2010;Santervas, et al, 2010;Shavit, Kofman, Leder, Hod, & Kozer, 2009;Strout & Baumann, 2011). The most common method to identify pain assessment practices in the emergency department has been through survey and retrospective chart review (Alexander & Manno, 2003;Jadav, Lloyd, McLauchlan, & Hayes, 2009;Kaplan, Sison, & Platt, 2008;Kleiber, Jennisen, McCarthy, Ansley, 2011;May et al, 2009;Porter & Chapman, 2004;Probst et al, 2005;Santervas et al, 2010;Strout & Baumann, 2011); however, healthcare providers' have been found to report better pain assessment practices on surveys then when compared to actual practice (Read, 1994;Twycross, 2007b;Twycross, 2008).…”

“…The overall documentation rates of pediatric pain measurement in the ED setting remains low (Drendel et al, 2006;Kaplan et al, 2008;Kleiber et al, 2011;Porter & Chapman, 2004;Probst et al, 2005). Two national surveys were located with one focused on pediatric pain assessment in the ED setting, and the other on pediatric pain assessment practices in teaching hospitals.…”

“…Studies have continuously shown pain management to be deficient in pediatric patients treated in the emergency department setting (Alexander & Manno, 2003;Bhargava & Young, 2007;Brown, Klein, Lewis, Johnston, & Cummings, 2003;Cimpello, Khine, & Avner, 2004;Cordell, et al, 2002;Drendel, Brousseau, & Gorelick, 2006;MacLean, Obispo, & Young, 2007;Probst, Lyons, Leonard, & Esposito, 2005;Rupp & Delaney, 2004). For example, Bhargava and Young (2007) documented only 38% of pediatric patients were provided with some form of pharmacological pain management for intravenous catheter placement, and MacLean, Obispo, and found that less than 1% of patients received pain management for venipuncture or intravenous line placement.…”

Intraurethral Lidocaine for Urethral Catheterization in Children: A Randomized Controlled Trial

“…5,6 There is ample evidence that analgesia is underused in the ED setting. [7][8][9][10] Furthermore, untreated pain in childhood has been reported to lead to slower healing [11][12][13][14] and long-term issues, such as anxiety, needle phobia, 15 hyperesthesia, 13 and fear of medical care. 16 Despite general acceptance that children experience significant pain-related urethral procedures, [17][18][19] suboptimal analgesia is particularly prevalent in children undergoing UC, with analgesic rates ranging from 0% 6 to 2%.…”