Korean J Pain.  2020 Oct;33(4):386-394. 10.3344/kjp.2020.33.4.386.

Pain Passport as a tool to improve analgesic use in children with suspected fractures in emergency departments

Affiliations
  • 1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
  • 2Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnan, Korea
  • 3Department of Emergency Medicine, Ajou University Hospital, Suwon, Korea

Abstract

Background
In the emergency department (ED), adequate pain control is essential for managing patients; however, children with pain are known to receive less analgesia than adults with pain. We introduce the Pain Passport to improve pain management in paediatric patients with suspected fractures in the ED.
Methods
This was a before-and-after study. We reviewed the medical records of paediatric patients who were primarily diagnosed with fractures from May to August 2015. After the introduction of the Pain Passport, eligible children were enrolled from May to August 2016. Demographics, analgesic administration rates, time intervals between ED arrival and analgesic administration, and satisfaction scores were obtained. We compared the analgesic prescription rate between the two periods using multiple logistic regression.
Results
A total of 58 patients were analysed. The baseline characteristics of subjects during the two periods were not significantly different. Before the introduction of the Pain Passport, 9 children (31.0%) were given analgesics, while after the introduction of the Pain Passport, a significantly higher percentage of patients (24/29, 82.8%) were treated with analgesics (P < 0.001). The median administration times were 112 (interquartile range [IQR], 64-150) minutes in the pre-intervention period and 24 (IQR, 20-74) minutes in the post-intervention period. The median satisfaction score for the post-intervention period was 4 (IQR, 3-5). The adjusted odds ratio for providing analgesics in the post-intervention period was 25.91 (95% confidence interval, 4.36-154.02).
Conclusions
Patient-centred pain scoring with the Pain Passport improved pain management in patients with suspected fractures in the paediatric ED.

Keyword

Analgesia; Analgesics; Child; Emergency Medical Services; Fractures; Bone; Pain; Pain Management; Standard of Car

Figure

  • Fig. 1 The Pain Passport used in this study (translated version). (A) The fourth page of the Pain Passport. This page contains a satisfaction survey (5-point Likert scale) and an additional puzzle. (B) The first page of the Pain Passport. This page contains the title and a blank for the patient’s name and identification number. (C) The second page of the Pain Passport. This page explains the importance of pain management and the purpose of the Pain Passport; it also contains instructions on when and how to complete the Pain Passport. (D) The third page of the Pain Passport. The upper half of the page explains the two pain scoring methods, the Wong-Baker Pain Scale and Numeric Rating Scale, and the lower half consists of a table to provide the pain score at each time point.

  • Fig. 2 Timeline of post-intervention period. The pain score was reported by children and/or guardian up to four stages and analgesics was prescribed depending on the reported pain score. Pain score was re-evaluated 30 minutes after analgesics administration. ED: emergency department.

  • Fig. 3 Flow chart of patients enrolled in this study. ED: emergency department, NRS: Numeric Rating Scale.

  • Fig. 4 The change in each patient’s pain score before and after the administration of analgesics in post-intervention group. A solid arrow indicates a change in the pain score of a single child, a dotted arrow indicates that there are two children corresponding to the change of the pain score, and a dashed arrow indicates that there are four children corresponding to the change of the pain score.

  • Fig. 5 Distribution of satisfaction scores of the patients and guardians.


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