How does the introduction of a pain and sedation management guideline in the paediatric intensive care impact on clinical practice? A comparison of audits pre and post guideline introduction

Abstract

Despite the use of guidelines to inform practice for pain and sedation management there are few evaluations of the effect of their introduction on clinical practice. Previous evaluations of the protocols and guidelines used to manage pain and sedation in the paediatric intensive care unit (PICU) report increases in pain and sedation medication administration post guideline introduction. In most reported cases the guideline was accompanied by a treatment algorithm. To our knowledge there is no published data on the effect of introducing a guideline without a treatment algorithm on pain and analgesia administration.

Purpose: To evaluate the impact the introduction of a pain and sedation guideline will have on clinical practice.

Methods: A 19 bed PICU was audited for one month prior to the introduction of a guideline and one month post.

Findings: The proportion of patients receiving oral Clonidine increased (p=0.001) and the administration of Ketamine, particularly via bolus (p=0.003), reduced after the introduction of the guideline. The use of a validated pain tool to assess pain increased by 25% and communication of management plans increased by 25%. The documentation of the use of boluses increased by 36%.

Conclusion: The introduction of a clinical practice guideline for pain and sedation management in PICU contributes to changes in medication administration, use of validated pain assessments, improved documentation of boluses and communication of management plans.

Keywords: Anaesthesia and analgesia; Paediatric intensive care; Pain management; Practice guideline.