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Neta Bar Am,1 Jennifer Thull-Freedman,1 Samina Ali2 1Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 2Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, and Women and Childrenâs Research Institute, University of Alberta, Edmonton, Alberta, CanadaCorrespondence: Samina AliDepartment of Pediatrics, 3-582 Edmonton Clinic Health Academy, 11405 â 87 Avenue, Edmonton, Alberta, T6G 1C9, CanadaTel +1 780 248-5575Fax +1 888 775-8876Email sali@ualberta.caPurpose: Many rural and community emergency departments (EDs) experience barriers to providing optimal pain care to children. In preparation for a quality improvement initiative, our team conducted a provincial pediatric pain management practice and needs assessment.Methods: An online survey was sent to ED administrators and educators from March to May 2017. Themes included pain assessment, pain and distress management strategies, available resources, education, barriers to care, and opportunities for improvement.Results: Forty-five respondents, from 31 EDs representing all five geographic health zones in Alberta, completed the survey. Use of a pain assessment tool was reported at 93.5% (29/31 sites) of the sites. Topical anesthesia was employed âmost of the timeâ before suturing at 67% (18/27) of sites, versus 15% (4/27) before blood work or IV insertion. Eighty-one percent (22/27) of sites reported physically restraining children for procedures âoftenâ, while 37% (10/27) reported use of comfort positioning âoftenâ. Digital distraction devices were available at 37% (10/27) of sites. Reported challenges included lack of resources (33.3%, 12/36), staff education/knowledge (33.3%, 12/36), and absent policies/poor policy adherence (25.0%, 9/36). Opportunities for improvement included staff member education (73.5%, 25/34) and more resources (58.8%, 20/34). Respondents rated their siteâs overall ability to manage childrenâs pain as 50/100 [IQR:21,61].Conclusion: General EDs report providing suboptimal childrenâs pain care, with use of physical restraint for medical procedures, and under-utilization of evidence-based, inexpensive treatment options. There are many gaps in childrenâs pain care in rural and community EDs which could be addressed through collaborative quality improvement initiatives.Keywords: children, rural, procedural pain, pain treatment |
