Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals

Abstract

BackgroundPain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational factors.MethodsA structured questionnaire was mailed to all the 14 Italian pediatric and maternal and child hospitals and to 5 general hospitals with separate pediatric emergency room. There were no refusals. Information collected included the frequency and mode of pain assessment, presence of written pain management protocols, use of local anaesthetic (EMLA cream) before venipuncture, and role of parents. General data on the hospital and ED were also recorded. Multiple Correspondence Analysis was used to explore the multivariable associations between the characteristics of hospitals and EDs and their pain management policies and practices.ResultsRoutine pain assessment both at triage and in the emergency room was carried out only by 26% of surveyed EDs. About one third did not use algometric scales, and almost half (47.4%) did not have local protocols for pain treatment. Only 3 routinely reassessed pain after treatment, and only 2 used EMLA. All EDs allowed parents’ presence and most (17, 89.9%) allowed them to stay when painful procedures were carried out. Eleven hospitals (57.9%) allowed parents to hold their child during blood sampling. Pediatric and maternal and child hospitals, those located in the North of Italy, equipped with medico-surgical-traumatological ED and short stay observation, and providing full assessment triage over 24 hours were more likely to report appropriate policies for pain management both at triage and in ER. A nurses to admissions ratio ≥ median was associated with better pain management at triage.ConclusionsDespite availability of national and international guidelines, pediatric pain management is still sub-optimal in Italian emergency departments. Multifaceted strategies including development of local policies, staff educational programs, and parental involvement in pain assessment should be carried out and periodically reinforced.

A Randomized Clinical Trial of Jet-Injected Lidocaine to Reduce Venipuncture Pain for Young Children

“…4 This variation mirrors inconsistent practices seen in emergency departments regarding the treatment of procedural pain in children. 21,22 Though the children seen in the outpatient lab were generally well at the time of their venipuncture, the experience of a needle stick for outpatient venipuncture is similar to that of children undergoing venipuncture in the emergency department. Similarly, the act of using a needle to obtain blood is less invasive but similar to the placement of an IV catheter.…”

The Feasibility of Using the BrightHearts Biofeedback‐Assisted Relaxation Application for the Management of Pediatric Procedural Pain: A Pilot Study

“…The management of pain and anxiety in children undergoing medical procedures is a significant clinical issue; even minor procedures can lead to significant distress . Recent studies have reported that management of procedural pain in children is often suboptimal . Inadequate management of pain during a procedure can lead to the formation of an association between pain and the procedure, which can lead to the development of fear and anxiety related to the procedure and an aversion to medical care .…”

“…1,2 Recent studies have reported that management of procedural pain in children is often suboptimal. [3][4][5] Inadequate management of pain during a procedure can lead to the formation of an association between pain and the procedure, which can lead to the development of fear and anxiety related to the procedure and an aversion to medical care. [6][7][8][9] Enhanced anxiety related to a procedure can in turn exacerbate the perception of pain from a procedure.…”

Effects of postoperative pain management educational interventions on the outcomes of parents and their children who underwent an inpatient elective surgery: A randomized controlled trial

“…Parents' misconceptions on the tolerance, side effects and addiction of analgesics (Finley, Kristjansdottir, & Forgeron, 2009;Lim et al, 2012;Rony, Fortier, Chorney, Perret, & Kain, 2010) can lead to inadequate uses of pain medication for their children (Voepel-Lewis, Zikmund-Fisher, Smith, Zyzanski, & Tait, 2015), especially when conflicting symptoms like high pain and an adverse effect are present (Longard et al, 2016;Voepel-Lewis et al, 2015). This might be one of the reasons why children's postoperative pains are undertreated (Avian et al, 2016;Chieng et al, 2013;Ferrante et al, 2013;Twycross & Collins, 2013b).…”