1626 Improving Pain Management in Tertiary Pediatric Hospital- High Hopes and Ordinary Problems

Abstract

Background and Aims Observation of pain management problems in tertiary pediatric hospital (Children's Memorial Health Institute, Warsaw, Poland) resulted in anaesthesia and intensive care team initiative of pain practice improvement. Methods In November 2011 Pain Treatment Committee represented by 22 doctors and 20 nurses of all hospital departments was established. In November/December 2011 pilot training programme for nurses of Pediatric Urology, Neurosurgery and Cardiac Surgery Departments was performed. In December 2011 written pain assessment and treatment guidelines accepted by the committee members and hospital administration where announced. They included: • obligatory pain intensity assessment with age/communication skills- appropriate tools (NIPS, FLACC, Wong- Baker, VAS). • pain treatment adequate to individual pain intensity with multimodal analgesia use. • restriction in muscular injections of analgesics. • analgesics dosing guidelines. • perioperative analgesia algorithms based on predicted pain intensity. Between February and March 2012 201 practitioners and 391 nurses participated in pain assessment and management seminars. Results Preliminary report on analgesia practice in surgical units revealed: • poor compliance with pain assessment guidelines . • 100% reduction in intramuscular opioid use in one of the departments. • improvement in analgesic prescriptions practice with individual variability between practitioners. • increase in number of pain consultations. • no improvement with use of regional analgesia, insufficient number of PCA pumps. Conclusions During few months after introducing hospital pain management guidelines we notice a change in pain practice but many problems still exist. Analgesia quality improvement is longterm process requiring multidisciplinary approach.