Pain as the neglected patient safety concern

Twycross, Alison; Forgeron, Paula; Chorne, Jill; Backman, Chantal; Finley, G. Allen

doi:10.1177/1367493516643422

Cited by 14 publications

(6 citation statements)

References 20 publications

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“…We understood that pain will vary greatly depending on the procedure and a number of patient factors. However, we agree with Chorney and et al 31,32 that "inadequately managed pain meets the definition of an AE and … that treating pain as an AE may improve care by raising… awareness of this issue." 32 We also understand that the practical application of our proposed classification system will be challenging as the dental profession is not accustomed to evaluating and tracking the pain experience, as is commonplace in the medical profession (e.g., postoperative pain scales, etc.).…”

Section: Discussionsupporting

confidence: 76%

Classifying Adverse Events in the Dental Office

et al. 2017

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Background Dentists strive to provide safe and effective oral healthcare. However, some patients may encounter an adverse event (AE) defined as “unnecessary harm due to dental treatment”. In this research we propose and evaluate two systems for categorizing the type and severity of AEs encountered at the dental office. Methods Several existing medical AE type and severity classification systems were reviewed and adapted for dentistry. Using data collected in prior work, two initial dental AE type and severity classification systems were developed. Eight independent reviewers performed focused chart reviews and AEs identified were used to evaluate and modify these newly developed classifications. Results 958 charts were independently reviewed. Among the reviewed charts, 118 prospective AE’s were found and 101 (85.6%) were verified as AEs through a consensus process. At the end of the study, a final AE Type classification comprising 12 categories, and an AE severity classification comprising 7 categories emerged. Pain and infection were the most common AE types representing 75% of the cases reviewed (55% and 17% respectively) and 88% were found to cause temporary, moderate to severe harm to the patient. Conclusions AEs found during the chart review process were successfully classified using the novel dental AE type and severity classifications. Understanding the type of AEs and their severity are important steps if we are to learn from and prevent patient harm in the dental office.

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Section: Discussionsupporting

confidence: 76%

Classifying Adverse Events in the Dental Office

et al. 2017

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“…19 It can also predispose infants, children, and adolescents to endure repeated procedural pain,20 and can then lead to a culture of poor pain management practice. 21,22 Variability in the experience and expression of pain may be a further contributing factor to dominant misconceptions and myths held in society that inhibit access to pain management.…”

Section: Social Organisationmentioning

confidence: 99%

Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission

Eccleston

Fisher

Howard

et al. 2021

The Lancet Child & Adolescent Health

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195

278

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Every baby, child and adolescent will experience pain at times throughout their life. Despite its ubiquity, pain is a major challenge for individuals, families, healthcare professionals, and societies. Pain is often hidden and can go undiscussed or ignored. Undertreated, unrecognised, or poorly managed pain in childhood leads to important and long-lasting negative consequences that continue into adulthood. This undertreatment should not continue. We have the tools, expertise, and evidence to provide better treatment for childhood pain.In this Commission we present four transformative goals that will, if achieved, transform the lives of children with pain and their families. These goals, taken at face value, may seem simple and obvious. However, if the goals were easy to achieve there would be few, if any, young people reporting poorly managed acute pain, pain after surgery or procedures, or ongoing chronic pain. Pain is multifactorial, and influenced by biological, psychological and social factors, making it complex and difficult to treat effectively, especially in infants, children and adolescents. This Commission focusses on children from birth through to 24 years of age in developed countries.The first transformative goal is to 'make pain matter'. Here we argue that pain has not mattered enough, as evidenced by common failings in clinical practice, low levels of training and investment, and a lack of concern for issues of equity and equality. Despite some good examples of knowledge translation, we highlight that investment in a strong social science research base for paediatric pain will catapult us into a new era in which we can address the social and cultural context of pain.The second is to 'make pain understood' at a fundamental biological and psychological level. There has been excellent progress in mechanistic understandings of nociception and pain perception for both acute and chronic pain states but gaps in knowledge remain. Advances in developmental biology, in genetics, in psychology, and in nosology and classification will all help speed up the discovery in these areas. There is also a need for greater investment in larger international birth cohort studies that incorporate comprehensive pain-related measurement incorporated.The third is to 'make pain visible'. Pain can and should be assessed. We need to help improve understanding of optimal methods for pain assessment at throughout childhood and in all clinical scenarios. While subjective pain report is the primary and desirable method when this is possible, many of the methods and measures that are in common use can and should be improved. There has been development in understanding the biological correlates of pain, and in broader patient reported outcome variables that can expand our horizons. Finally, we should be more focussed on assessing outcomes that are important to patients, rather than those that are central to researchers and clinicians.The fourth is to 'make pain better' by advancing our knowledge of multiple treatment options in all a...

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“…Pediatric pain is common, occurs across variety of settings [e.g., everyday pains (minor injuries resulting in bumps and bruises), vaccine injections, medical procedures, surgeries], and, despite advancements in pain assessment and management, remains poorly managed ( 1 ). To date, research on how language influences child pain has largely focused on the children's immediate painful experience.…”

Section: Introductionmentioning

confidence: 99%

Let's (Not) Talk About Pain: Mothers' and Fathers' Beliefs Regarding Reminiscing About Past Pain

et al. 2022

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Children's memories for past pain set the stage for their future pain experiences. Parent-child reminiscing about pain plays a key role in shaping children's pain memories. Parental beliefs about the functions of reminiscing are associated with parental reminiscing behaviors. To date, no studies have investigated parental beliefs regarding the functions of reminiscing about past pain or the associations between parental beliefs and reminiscing about past pain. This study aimed to fill these gaps. One-hundred and seven parents (52% fathers) of young children were asked about their beliefs regarding reminiscing about past pain. Interview data were first analyzed using inductive reflexive thematic analysis. A coding scheme was created based on the generated themes to quantitatively characterize parental beliefs. Parents also reminisced with their children about unique past events involving pain. Parent-child reminiscing narratives were coded to capture parent reminiscing behaviors. Inductive reflexive thematic analysis generated three major themes representing parental beliefs regarding reminiscing about past pain: “reminiscing to process past pain,” “reminiscing as a learning tool,” and “avoiding reminiscing about past pain.” Parents who endorsed avoiding reminiscing used fewer optimal reminiscing elements (i.e., open-ended questions) when reminiscing about past painful experiences with children. Parents who endorsed reminiscing to process past pain used more emotion-laden language when reminiscing about past pain. Mothers and fathers of boys and girls endorsed the reminiscing functions to a similar degree. Parents of older, vs. younger, children endorsed reminiscing to process past pain to a greater degree. Developmental considerations and clinical implications of the findings are discussed.

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Pain as the neglected patient safety concern

Cited by 14 publications

References 20 publications

Classifying Adverse Events in the Dental Office

Classifying Adverse Events in the Dental Office

Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission

Let's (Not) Talk About Pain: Mothers' and Fathers' Beliefs Regarding Reminiscing About Past Pain

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