A Paradigm Shift to Balance Safety and Quality in Pediatric Pain Management

Abstract

OBJECTIVE: Undertreating pain and inappropriate use of opioids are potentially harmful to patients. We created a reliable process to discuss the pain plan preoperatively, hypothesizing that it will enhance the safety of opioid administration while improving the quality of pain management. METHODS: A multidisciplinary group was convened for a 3-day workshop where a reliable method for preoperative discussion of the pain plan was created for patients having ambulatory hernia repair. Four targets were defined: (1) pain management is discussed by the provider; (2) a pain plan is accurately documented in the electronic medical record; (3) parents perceive that pain is adequately discussed; and (4) behavioral indicators demonstrate the pain plan is effective. The goal was 100% compliance with targets at 60 days. A standard pain regimen was created. Data collection included chart review and a postoperative phone call. Patients were separated into 30-day postimplementation cohorts for evaluation of their hernia. Analysis was descriptive. RESULTS: A total of 235 patients had hernia repair. Discussion and documentation of pain occurred in 73% at 240 days (n = 15). Providers entered orders for postoperative pain in 80% at 240 days after implementation. Parents reported that pain was adequately discussed and treated between 87% and 100% of the time. CONCLUSIONS: Balancing the potential harm from undertreating pain and inappropriate use of opioids requires an evidence-based, multidisciplinary family-centered approach. The development and implementation of a reliable method for the management and treatment of pain reduces variability allowing for delivery of safe and quality care.