Friedrichsdorf Stefan J, Postier Andrea, Eull Donna, Weidner Christian, Foster Laurie, Gilbert Michele, Campbell Fiona
Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; University of Minnesota Medical School, Minneapolis, Minnesota;
Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota;
Hosp Pediatr. 2015 Jan;5(1):18-26. doi: 10.1542/hpeds.2014-0084.
Pain in hospitalized children may be underrecognized and undertreated. The objective of this survey was to benchmark pain prevalence, intensity, assessment, and pharmacologic as well as integrative treatment of pain in inpatients in a US children's hospital.
This was a single-day, cross-sectional survey and electronic medical record review of inpatients who received medical care at a pediatric hospital. Inpatients and emergency department patients were asked to report their experience with pain and its management during the previous 24 hours.
Of 279 inpatients listed on the morning census, 178 children and parents were located and completed the survey. Seventy-six percent had experienced pain during the previous 24 hours, usually acute or procedural pain, 12% of whom possibly suffered from chronic pain. Twenty percent of all children surveyed experienced moderate and 30% severe pain in that time period. The worst pain reported by patients was caused by needle pokes (40%), followed by trauma/injury (34%). Children and their parents rated 5 integrative, nonpharmacologic modalities as more effective than medications. Pain assessments and management were documented in the medical record for 58% of patients covering the 24-hour period before the morning census. The most commonly prescribed analgesics were acetaminophen, morphine, and ibuprofen.
Despite existing hospital policies and a pain consult team, significant room for improvement in pain management was identified. A hospital-wide, 3-year Lean quality improvement initiative on reducing pain was commenced as a result of this survey.
住院儿童的疼痛可能未得到充分认识和治疗。本调查的目的是对美国一家儿童医院住院患者的疼痛患病率、强度、评估、药物治疗以及综合治疗进行基准评估。
这是一项对在儿科医院接受医疗护理的住院患者进行的单日横断面调查及电子病历回顾。住院患者和急诊科患者被要求报告他们在过去24小时内的疼痛经历及其管理情况。
在晨间普查列出的279名住院患者中，找到178名儿童及其家长并完成了调查。76%的患者在过去24小时内经历过疼痛，通常为急性疼痛或程序性疼痛，其中12%可能患有慢性疼痛。在该时间段内，所有接受调查的儿童中有20%经历了中度疼痛，30%经历了重度疼痛。患者报告的最严重疼痛是由针刺（40%）引起的，其次是外伤/损伤（34%）。儿童及其家长认为5种综合非药物治疗方法比药物更有效。在晨间普查前24小时内，58%患者的疼痛评估和管理记录在病历中。最常用的镇痛药是对乙酰氨基酚、吗啡和布洛芬。
尽管有现有的医院政策和疼痛咨询团队，但仍发现疼痛管理有显著的改进空间。基于本次调查，启动了一项为期3年的全院范围的精益质量改进计划，以减轻疼痛。
