A Paradigm Shift to Balance Safety and Quality in Pediatric Pain Management
| Autor: | Gary A. Walco, Shellie L. Stockfish, Lisa M. Peters, Jeffrey R. Avansino |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Education Patient safety Patient satisfaction Patient Education as Topic Multidisciplinary approach Humans Pain Management Medicine Hernia Quality of Health Care Patient Care Team Pain Postoperative business.industry Hernia repair medicine.disease Regimen Opioid Patient Satisfaction Pediatrics Perinatology and Child Health Ambulatory Physical therapy Interdisciplinary Communication Patient Safety business medicine.drug |
| Zdroj: | Pediatrics. 131:e921-e927 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.2012-1378 |
| Popis: | OBJECTIVE: Undertreating pain and inappropriate use of opioids are potentially harmful to patients. We created a reliable process to discuss the pain plan preoperatively, hypothesizing that it will enhance the safety of opioid administration while improving the quality of pain management. METHODS: A multidisciplinary group was convened for a 3-day workshop where a reliable method for preoperative discussion of the pain plan was created for patients having ambulatory hernia repair. Four targets were defined: (1) pain management is discussed by the provider; (2) a pain plan is accurately documented in the electronic medical record; (3) parents perceive that pain is adequately discussed; and (4) behavioral indicators demonstrate the pain plan is effective. The goal was 100% compliance with targets at 60 days. A standard pain regimen was created. Data collection included chart review and a postoperative phone call. Patients were separated into 30-day postimplementation cohorts for evaluation of their hernia. Analysis was descriptive. RESULTS: A total of 235 patients had hernia repair. Discussion and documentation of pain occurred in 73% at 240 days (n = 15). Providers entered orders for postoperative pain in 80% at 240 days after implementation. Parents reported that pain was adequately discussed and treated between 87% and 100% of the time. CONCLUSIONS: Balancing the potential harm from undertreating pain and inappropriate use of opioids requires an evidence-based, multidisciplinary family-centered approach. The development and implementation of a reliable method for the management and treatment of pain reduces variability allowing for delivery of safe and quality care. |
| Databáze: | OpenAIRE |
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