Sil Soumitri, Goldstein-Leever Alana, Travers Curtis, Gilleland-Marchak Jordan, Alexander Ashley, Thompson Beth, Griffin Anya, McCracken Courtney, New Tamara
Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, USA.
Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, USA.
Clin Pract Pediatr Psychol. 2019 Dec;7(4):335-346. doi: 10.1037/cpp0000277. Epub 2019 May 16.
Standardized pain assessment and interventions are recommended for youth hospitalized for pain. This quality improvement (QI) project integrated into a pediatric psychology service aimed to increase the standardized assessment of pain-related functional ability for youth with sickle cell disease (SCD) hospitalized for pain.
Children and adolescents (n=102) with SCD referred for psychology consultation for poor coping in response to pain during hospitalization completed a validated self-report of functional ability in addition to pain intensity during inpatient psychology visits. At the time of the quality initiative, routine and standardized assessment of pain-related functional ability was not integrated into standard clinical care. Plan, Do, Study, Act (PDSA) cycles determined the feasibility and addressed common barriers of routine assessment and documentation of pain-related functional ability among youth with SCD during inpatient psychology visits with the primary goal to increase assessment of functional ability to at least 85% among patients with SCD referred for pediatric psychology consultation to address pain management within 1 year.
Through iterative PDSA cycles, routine assessment of pain-related functional ability during psychology visits increased to an average of 93% over the course of 12 months. Routine, standardized assessment of functional ability was considered feasible within a pediatric psychology service.
CONCLUSIONS/LESSONS LEARNED: This project supported the feasibility of integrating standardized assessment of functional ability to enhance pain assessment for youth hospitalized for SCD pain as part of routine clinical care in a multidisciplinary setting regardless of psychology referral.
对于因疼痛住院的青少年，建议进行标准化的疼痛评估和干预。这个融入儿科心理学服务的质量改进（QI）项目旨在提高对因疼痛住院的镰状细胞病（SCD）青少年与疼痛相关的功能能力的标准化评估。
因住院期间应对疼痛时应对能力差而被转介进行心理学咨询的患有SCD的儿童和青少年（n = 102），除了在住院心理就诊时报告疼痛强度外，还完成了一份经过验证的功能能力自我报告。在开展质量改进举措时，与疼痛相关的功能能力的常规和标准化评估并未纳入标准临床护理。计划-实施-研究-改进（PDSA）循环确定了可行性，并解决了在住院心理就诊期间对患有SCD的青少年进行与疼痛相关的功能能力的常规评估和记录的常见障碍，主要目标是在1年内将转介至儿科心理学咨询以解决疼痛管理问题的SCD患者中功能能力的评估比例提高到至少85%。
通过反复的PDSA循环，在12个月的时间里，心理就诊期间与疼痛相关的功能能力的常规评估平均提高到了93%。在儿科心理学服务中，功能能力的常规标准化评估被认为是可行的。
结论/经验教训：该项目支持了将功能能力的标准化评估纳入其中的可行性，以加强对因SCD疼痛住院的青少年的疼痛评估，作为多学科环境中常规临床护理的一部分，无论是否有心理学转介。
