Routine pain scoring does not improve analgesia provision for children in the emergency department

• Published in: Emergency medicine journal : EMJ Vol. 26; no. 10; pp. 695 - 697
• Main Authors: Jadav, M A R, Lloyd, G, McLauchlan, C, Hayes, C
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01.10.2009; BMJ Publishing Group LTD
• Subjects: Analgesia - utilization; Analgesics; Analgesics - therapeutic use; Audits; Child; Child Health Services; Diagnostic Tests, Routine; Documentation; Emergency medical care; Emergency Service, Hospital; Fractures; Humans; Injuries; Narcotics; Nonsteroidal anti-inflammatory drugs; Nurses; Pain - diagnosis; Pain - drug therapy; Pain management; Pain Measurement; Patients; Pediatrics; Process Assessment (Health Care)
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emj.2008.065193

Background: Scoring pain should lead to providing better analgesia for children attending the emergency department (ED). Our ED found that it offered analgesia to only 75% of children with painful injuries—36% of them receiving opiates, while scoring pain in 74%. This report describes what happened when we tried to ensure every child had their pain scored in an effort to improve analgesia provision. Methods: We ensured mandatory pain scoring at triage during the introduction of our computerised notes system, backing this up with extra training of new staff and increased publicity of pain scoring tools. A retrospective audit was conducted after the intervention looking for completion of a pain score, provision of and type of analgesia. The study included children with long bone fractures or partial or full-thickness burns attending the ED. Results: Following the intervention, we found that of 163 children, 97% had their pain scored on a zero-to-10 scale but only 66% received analgesia and only 10% were given opiates. Conclusions: The intervention was effective at achieving nearly universal early assessment and documentation of pain. This did not translate to an improvement in analgesic provision. Other means of changing behaviour need to be studied, possibly using the computerised record again to obligate analgesia provision.