Paediatric pain assessment and management in the emergency setting: the impact of a paediatric pain bundle.

OBJECTIVES: To evaluate the impact of a paediatric pain bundle on pain assessment and management of children with fractured forearms who presented to an Emergency Department (ED).

METHODS: A descriptive, comparative pilot study was conducted at a large regional hospital ED to describe differences in pain assessment, management and documentation in the 4months before and after the implementation of a paediatric pain bundle.

RESULTS: A total of 242 children with fractured forearms visited the ED over two separate 4-month periods during 2009. Compared to the pre time period, children in the post time period did not differ significantly regarding pain assessment score documentation (13.5% vs. 20.7%, p=0.14), administration rate of analgesia (58.7% vs. 65.5%, p=0.28) or time to analgesia (28min vs. 35min, p=0.22).

CONCLUSIONS: In this pilot study, findings indicated clinical significance but not statistical significance. The assessment and management of pain in the ED paediatric population is challenging due to difficulties interpreting responsiveness and to organisational and system imperatives that delay time critical aspects such as time to analgesia. Further focus on documentation, assessment and management practices is required in larger populations across a number of sites.