Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals

被引:32
|
作者
Ferrante, Pierpaolo [1 ]
Cuttini, Marina [1 ]
Zangardi, Tiziana [2 ]
Tomasello, Caterina [3 ]
Messi, Gianni [4 ]
Pirozzi, Nicola [3 ]
Losacco, Valentina [1 ]
Piga, Simone [1 ]
Benini, Franca [5 ]
机构
[1] Bambino Gesu Pediat Hosp, Epidemiol Unit, I-00146 Rome, Italy
[2] Univ Hosp, Dept Emergency Med, Padua, Italy
[3] Bambino Gesu Pediat Hosp, Dept Emergency Med, I-00146 Rome, Italy
[4] Burlo Garofolo Childrens Hosp, Dept Emergency Med, Trieste, Italy
[5] Univ Hosp, Dept Pediat, Padua, Italy
来源
BMC PEDIATRICS | 2013年 / 13卷
关键词
Pediatric pain management; Algometric scales; Emergency care; Policies; PROCEDURAL PAIN; CHILDREN; ANALGESIA; DEPARTMENTS; COUNTRIES; PARENTS; UNITS; COMMUNITY; PATTERNS; VIEWS;
D O I
10.1186/1471-2431-13-139
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Background: Pain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational factors. Methods: A structured questionnaire was mailed to all the 14 Italian pediatric and maternal and child hospitals and to 5 general hospitals with separate pediatric emergency room. There were no refusals. Information collected included the frequency and mode of pain assessment, presence of written pain management protocols, use of local anaesthetic (EMLA cream) before venipuncture, and role of parents. General data on the hospital and ED were also recorded. Multiple Correspondence Analysis was used to explore the multivariable associations between the characteristics of hospitals and EDs and their pain management policies and practices. Results: Routine pain assessment both at triage and in the emergency room was carried out only by 26% of surveyed EDs. About one third did not use algometric scales, and almost half (47.4%) did not have local protocols for pain treatment. Only 3 routinely reassessed pain after treatment, and only 2 used EMLA. All EDs allowed parents' presence and most (17, 89.9%) allowed them to stay when painful procedures were carried out. Eleven hospitals (57.9%) allowed parents to hold their child during blood sampling. Pediatric and maternal and child hospitals, those located in the North of Italy, equipped with medico-surgical-traumatological ED and short stay observation, and providing full assessment triage over 24 hours were more likely to report appropriate policies for pain management both at triage and in ER. A nurses to admissions ratio >= median was associated with better pain management at triage. Conclusions: Despite availability of national and international guidelines, pediatric pain management is still sub-optimal in Italian emergency departments. Multifaceted strategies including development of local policies, staff educational programs, and parental involvement in pain assessment should be carried out and periodically reinforced.
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页数:9
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