Acute Post-operative Pain Assessment And Management Audit In Children Aged Three To Twelve Years At Gertrude's Children's Hospital

Abstract

Background: Pain assessment and management in children continues to be a challenge. Royal College of Nursing has published best practice standards for acute pain assessment, while World Health Organisation has developed guidelines for management of pain. The extent to which the guidelines have been implemented is not known. Objective of the study: To carry out an audit on the current methods of acute pain assessment and management for postoperative children aged 3-12 years at Gertrude's Children's Hospital. Study Participants: Children aged 3-12 years who had undergone surgery at Gertrude's Children's Hospital (GCH), and were without any cognitive impairment. Study design and Methodology: This was a two part hospital-based cross-sectional study involving retrospective random review of 72 patient records and 26 semiquantitative health worker interview. Joanna Briggs Institute Practical Application of Clinical Evidence System tool was used to compare current practices with best practice. The data was analyzed using STATA version 11 Software. P-values of less than 0.05 were considered statistically significant. Qualitative data in health worker interview data was classified into themes and categorized to define concepts and then analyzed using ATLAS.Ti v.7 free trial version. Spearman's Rank correlation was done to compare and establish the independence of various variables. Logistic regression modeling was used to determine the risk factors for poor pain control. Results: Our study showed male preponderance (58.3 %). Median age of children was 4 years (IQR 3-7). Documentation of incidences of inadequate pain control was the most important variable, and was 59 times more likely to result in analgesic step up (adjusted OR 59.1; 95 % CI 9.9-352.9). There was poor compliance to best practice for pain assessment (50%) and pain reassessments (1%). The main barriers to pain assessment and management were inadequate staff knowledge and skills, lack of validated tools and negative attitudes towards opioids use. Recommendation: Members of staff should be sensitized on appropriate pain assessment and management and unjustified fear of opioid analgesics should be corrected using various educational approaches.