Pediatric Pain Assessment in the Emergency Department: A Nursing Evidence-Based Practice Protocol
Michele Habich and MariJo Letizia
Background: Many children present to the emergency department (ED) in pain
and/or experience pain as a result of interventions necessary to manage their illness.
Pediatric pain assessment and management is complex and challenging.
Despite the presence of published standards of care specific to pain assessment
and management, nurses in the ED may not know about and/or consistently use
these evidence-based practices. In particular, pediatric patients are inconsistently
and/or inappropriately assessed for pain in the ED.
Methods: The aim of this project was to make standard the utilization of evidence- based practices regarding pediatric pain assessment in the ED at a community hospital. The purpose of this project was to develop, implement, and evaluate a pediatric pain education program and pain assessment protocol to improve nurses' knowledge and standardize care in a community hospital emergency department.
Results: Seventy-eight ED nurses completed the education program, consisting of an online module with content addressing pediatric pain assessment and management, and then used the protocol. Education program evaluations were very positive. A statistically significant difference in the mean pre- and post-test scores indicated significant learning gains among participants; strong reliability of this test was demonstrated. Sixty patient medical records were reviewed two weeks after the educational program. Pain assessment at triage and use of an appropriate pain scale for all assessments were the most consistently used components of the protocol. A low percentage of protocol adherence was found regarding assessment of pain characteristics.
Conclusion: Significant improvements in nurses' pain knowledge are demonstrated via an education program. Implementation of a pain assessment protocol is one mechanism to standardize nursing practice with pediatric patients in the ED setting.