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  1. Joanna Shaw,
  2. Rachael Fothergill,
  3. Gurkamal Virdi
  1. London Ambulance Service NHS Trust, London, UK


Introduction Pain is one of the most frequently reported symptoms to UK ambulance services and pain management is a known area for improvement. This is especially true for paediatric patients who may not be able to communicate their levels of pain as effectively as adults.

Method A criterion-based retrospective clinical audit evaluated pain assessment and management for children less than 12 years old who reported a suspected fracture. To determine how pain assessments could be improved, an investigation of pain assessment methods used in other areas of the NHS was undertaken. A laminated card was produced and distributed to all clinicians for use when assessing pain in children. The card contains an amended version of the Wong-Baker faces to help clinicians assess and monitor paediatric patients' levels of pain with a reminder of the analgesic options available for children. Paediatric pain assessment and pain management was re-audited following introduction of the card.

Results Prior to introduction of the card, the data showed paediatric pain management as a considerable area of concern for the ambulance service. A pain assessment was undertaken for 64% of patients. When a pain assessment was undertaken, and the child reported they were in pain, only 23% of patients received pharmacological pain relief. The introduction of the card resulted in great improvements. A pain assessment was documented for 96% of patients, representing an improvement of 32% from the original audit. When analgesia was indicated, it was administered to 66% of patients, an improvement of 43%. Despite this improvement, pain was still not managed effectively for 34% of patients.

Conclusion Further improvement is required to ensure every paediatric patient has their pain assessed and managed effectively. The laminated card has been redesigned and distributed, in conjunction with a pain training strategy. In addition, further analgesic options for paediatric patients have been investigated.

  • emergency department

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