Schuman Sarah S, Regen Rebecca B, Stuart Lindsay H, Harrell Camden, Jones Tamekia L, Stewart Barbara M, Berg Allyson M, Longjohn Mindy, Kink Rudy J
Department of Pharmacy, Le Bonheur Children's Hospital, Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center.
Children's Foundation Research Institute, Le Bonheur Children's Hospital.
Pediatr Qual Saf. 2018 Nov 15;3(6):e120. doi: 10.1097/pq9.0000000000000120. eCollection 2018 Nov-Dec.
Pain management is a critical aspect of effective long bone fracture treatment. Pediatric patients frequently report suboptimal pain management, which is an area of growing public concern. The purpose of this quality improvement project was to develop a protocol with the goal to administer pain medication to children presenting with suspected long bone fractures ≤47 minutes of emergency department arrival.
A multidisciplinary team developed a standardized protocol for pain management of patients presenting with musculoskeletal pain utilizing acetaminophen as the first-line agent under a nurse-initiated order. Following education and implementation, weekly reports generated using the International Classification of Diseases codes of fractures were reviewed to assess compliance with the protocol. This study evaluates the frequency of a second pain medication administration and reduction in vital signs and pain scores.
Implementation of a pain management protocol reduced median time to pain medication administration to 26 minutes. Overall, 63% (n = 638) of patients required a second pain medication. Of these, 66.5% (348/523) who initially received acetaminophen and 59.7% (286/479) who initially received an opioid required a second pain medication. No significant changes in pre and posttreatment vital signs were found between groups. Patients who initially received opioids experienced a greater reduction in posttreatment pain scores.
Using a standardized pain management protocol in combination with comprehensive education effectively reduces median time to pain medication administration in pediatric patients with long bone fractures. Acetaminophen is a rapid and effective first-line agent for managing pain in this population.
疼痛管理是有效治疗长骨骨折的关键环节。儿科患者经常报告疼痛管理效果欠佳，这一领域日益受到公众关注。本质量改进项目的目的是制定一项方案，目标是在疑似长骨骨折的儿童到达急诊科后≤47分钟内给予止痛药物。
一个多学科团队制定了一项标准化方案，用于管理出现肌肉骨骼疼痛的患者的疼痛，以对乙酰氨基酚作为护士发起医嘱下的一线用药。在进行教育和实施后，审查了使用国际疾病分类骨折编码生成的每周报告，以评估对该方案的依从性。本研究评估了第二次给予止痛药物的频率以及生命体征和疼痛评分的降低情况。
实施疼痛管理方案后，给予止痛药物的中位时间缩短至26分钟。总体而言，63%（n = 638）的患者需要第二次给予止痛药物。其中，最初接受对乙酰氨基酚的患者中有66.5%（348/523），最初接受阿片类药物的患者中有59.7%（286/479）需要第二次给予止痛药物。两组之间治疗前后的生命体征无显著变化。最初接受阿片类药物的患者治疗后的疼痛评分降低幅度更大。
使用标准化疼痛管理方案并结合全面教育，可有效缩短长骨骨折儿科患者给予止痛药物的中位时间。对乙酰氨基酚是该人群管理疼痛的快速有效一线用药。
