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. 2014 Apr;19(4):190-4.
doi: 10.1093/pch/19.4.190.

Paediatric pain management practice and policies across Alberta emergency departments

Samina Ali  1 , Andrea L Chambers  2 , David W Johnson  3 , William R Craig  1 , Amanda S Newton  1 , Ben Vandermeer  2 , Sarah J Curtis  1
Affiliations

Paediatric pain management practice and policies across Alberta emergency departments

Samina Ali et al. Paediatr Child Health. 2014 Apr.

Abstract
in English, French

Background: Many children requiring acute care receive suboptimal analgesia.

Objectives: To describe paediatric pain management practices and policies in emergency departments (EDs) in Alberta.

Methods: A descriptive survey was distributed to each of the EDs in Alberta.

Results: A response rate of 67% (72 of 108) was obtained. Seventy-one percent (42 of 59) of EDs reported the use of a pain tool, 29.3% (17 of 58) reported mandatory pain documentation and 16.7% (10 of 60) had nurse-initiated pain protocols. Topical anesthetics were reported to be used for intravenous line insertion by 70.4% of respondents (38 of 54) and for lumbar puncture (LP) by 30.8% (12 of 39). According to respondents, infiltrated anesthetic was used for LP by 69.2% (27 of 39) of respondents, and oral sucrose was used infrequently for urinary catheterization (one of 46 [2.2%]), intravenous line insertion (zero of 54 [0%]) and LP (one of 39 [2.6%]).

Conclusions: Few Alberta EDs use policies and protocols to manage paediatric pain. Noninvasive methods to limit procedural pain are underutilized. Canadian paediatricians must advocate for improved analgesia to narrow this knowledge-to-practice gap.

Historique: De nombreux enfants qui ont besoin de soins aigus reçoivent une analgésie sous-optimale.

Objectifs: Décrire les pratiques et politiques de gestion de la douleur en pédiatrie dans les salles d’urgence (SU) albertaines.

Méthodologie: Chaque SU de l’Alberta a reçu un sondage descriptif.

Résultats: Les chercheurs ont obtenu un taux de réponse de 67 % (72 sur 108). Au total, 71 % des SU (42 sur 59) ont déclaré utiliser un outil de gestion de la douleur, 29,3 % (17 sur 58) ont déclaré exiger de consigner la douleur et 16,7 % (dix sur 60) disposaient de protocoles de gestion de la douleur initiés par les infirmières. Ainsi, 70,4 % des répondants (38 sur 54) recouraient à l’anesthésie topique pour insérer un cathéter intraveineux et 30,8 % (12 sur 39), pour effectuer une ponction lombaire (PL). De plus, 69,2 % des répondants (27 sur 39) utilisaient des injections d’anesthésique pour les PL et, rarement, du saccharose par voie orale pour un cathétérisme urinaire (un cas sur 46 [2,2 %]), l’insertion d’un cathéter intraveineux (zéro sur 54 [0 %]) et une PL (un sur 39 [2,6 %]).

Conclusions: Un petit nombre de SU albertaines sont dotées des politiques et protocoles pour gérer la douleur en pédiatrie. Les méthodes non invasives sont sous-utilisées pour limiter la douleur liée à des interventions. Les pédiatres canadiens doivent prôner une meil-leure analgésie pour réduire cet écart entre le savoir et la pratique.

Keywords: Analgesia; Emergency; Paediatrics; Pain; Survey.

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Figures

Figure 1)
Figure 1)
A Reported pain management practices for paediatric acute otitis media (n=53). B Reported pain management practices for paediatric femur fracture (n=57). Percentages refer to percentage of administrators who believed that the named intervention was used ‘often’ or ‘always’ in their emergency department. IV Intravenous
Figure 2)
Figure 2)
A Reported pain management practices for paediatric urinary catheterization (n=46). B Reported pain management practices for paediatric intravenous line insertion (n=54). C Reported pain management practices for paediatric lumbar puncture (n=39). Percentages refer to percentage of administrators who believed that the named intervention was used ‘often’ or ‘always’ in their emergency department
See this image and copyright information in PMC

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