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Routine pain scoring does not improve analgesia provision for children in the emergency department
  1. M A R Jadav1,
  2. G Lloyd1,
  3. C McLauchlan1,
  4. C Hayes2
  1. 1
    Emergency Department, Royal Devon and Exeter Hospital, Exeter, UK
  2. 2
    Department of Paediatrics, Royal Devon and Exeter Hospital, Exeter, UK
  1. Correspondence to Dr M A R Jadav, Emergency Department, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK; markjadav{at}doctors.org.uk

Abstract

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.

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Footnotes

  • Competing interests None.

  • Ethics approval This audit was carried out as part of the emergency department’s audit activity, sanctioned and supported by the Royal Devon and Exeter clinical audit department. No patient diagnosis or treatment was affected by the inclusion of anonymised information from their case notes in this study. Ethics committee approval has not been required.

  • Contributors MARJ abstracted the data and wrote the paper. GL edited the paper. CM and CH had the idea for the study and provided guidance on its implementation. CM established and chairs the ED pain management committee that introduced the intervention.

  • Related papers published Jabarin CZ and Lloyd G. Analgesia provision for isolated painful injuries in children – a UK/US comparison. Today’s Emergency 2008;14:43–6. This paper details the previous retrospective audit of analgesia provision to children with long bone fractures or burns in our ED and compares the results to a published US study. The data from this audit are used as a pre-intervention comparison for the data published in the current paper.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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