Running head: PAIN REASSESSMENT IN PEDIATRIC PATIENTS

Pain Reassessment in Pediatric Patients

Vera Nixon
Bon Secours Memorial School of Nursing
Quality and Safety in Nursing Practice I
NUR 3206
Ms. Garrett
October 18, 2015
Honor Code I pledge
Pain Reassessment in Pediatric Patients
Pain reassessment within the hour of an intervention is an area that on my unit of
pediatrics needs improvement on. As a unit, pediatrics has improved on pain interventions, but
reassessing the pain within the hour, as well as documentation of that reassessment, is an area
that the pediatric unit is constantly discussing and attempting to find ways to improve. A variety
of patients are admitted to the floor, with pain as one area for improvement, including but not
limited to general postoperative, sickle cell crisis, generalized abdominal pain, headache, and
orthopedic patients.
Our postoperative patients are one area of patients that directly demonstrates the effect of

PAIN REASSESSMENT IN PEDIATRIC PATIENTS WITHIN THE

increased risk for complications, longer hospitalizations, and longer recovery periods if pain isnt
well controlled (Campbell, 2013). Maintaining appropriate reassessments, to evaluate the
efficacy of the intervention, is crucial in the postoperative patients pain. If evaluation of
interventions arent timely, then the possibility of longer hospital stays or readmission once
discharged may increase (Campbell, 2013).
While the Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS) scores are not nationally reported at this time for pediatrics, it is still reported to the
hospital, and a report is run monthly. Pain management, specifically how often the pain was well
controlled and how often everything was done by the staff to help with the pain (Hospital
Consumer Assessment of Healthcare Providers and Systems [HCAHPS], 2015), is one topic that
remains one of the lowest for the pediatric floor. The pediatric manager further obtains reports
on pain assessments, which is an area that is consistently high for lack of success. The
combination of the low reassessment within an hour of intervention compliance with the low
HCAHPS scores related to pain management continue to plague the unit. With Medicare and
Medicaid reimbursement linking with HCAHPS scores, maintaining acceptable scores within the
unit is a necessity.
The Joint Commission has also developed requirements in relation to pain management
and reassessment of pain. Hospital accreditation now includes documentation of the pain score
used as well as the documentation of pain score reassessments after administration in order to
identify alleviating interventions (Kellogg, Fairbanks, OConnor, Davis, & Shah, 2012).
It has been shown that if a pediatric patient receives a pharmacological intervention
intravenously, the likelihood of reassessment of that pain greatly improves (Kellogg et al., 2012).
The issue arrives at the fact that the most common pharmacological intervention in pediatric

PAIN REASSESSMENT IN PEDIATRIC PATIENTS

patients is ibuprofen (Kellogg et al., 2012), which therefore indicates a smaller likelihood of pain
being reassessed, let alone in a timely manner. Specifically on our unit, ibuprofen and
acetaminophen are our first line of defense for pain. Although the Joint Commission requires
reassessment of pain following interventions, studies have shown that they arent consistently
documented within two hours, let alone within the hour (Kellogg et al., 2012).
Implications of appropriately reassessing pain within the hour of an intervention for
nursing includes an improvement of HCAHPS scores related to pain management. Pain
management is an important part of the patients stay, and control over their pain leads to an
increase in the HCAHPS scores. As it stands, as a whole, St. Marys hospital is both below the
Virginia and National average for pain management (Centers for Medicare & Medicaid Services,
2015). A second implication for nursing related to appropriate pain management is reducing the
amount of readmissions due to postoperative pain. If reassessments are not documented in a
timely manner, consistently, it is difficult for the medical staff to monitor the efficacy of the pain
intervention as well as how the patient is responding to said intervention (Corwin, Kessler,
Auerbach, Liang, & Kristinsson, 2012). Therefore if patients are not receiving adequate pain
management, but staff looking at the documentation observes no issues, the patient can be
discharged without adequate coverage, and end up coming back due to poor pain control.
When breaking down items that prevent the application of documentation of pain
reassessments within the hour fall within four main categories of environmental, equipment,
staffing, and policies. The policy itself of reassessment of pain within the hour causes stress
upon the staff, especially with consistently demonstrating a lack of meeting the hospital policy.
Therefore, looking at the causes to noncompliance of the policy identifies lack of staff, lack of
knowledge to the policy of the staff, a high census, lack of appropriate flags within Connect Care

PAIN REASSESSMENT IN PEDIATRIC PATIENTS

for pediatric scales, and insufficient WOWs (to stock one per room) as causes.

PAIN REASSESSMENT IN PEDIATRIC PATIENTS

References
Campbell, F. (2013). Improving postoperative pain outcomes for children [PowerPoint slides].
Retrieved from Centre for Pediatric Pain Research: International Forum on Pediatric Pain
(IFPP): http://pediatric-pain.ca/wp-content/uploads/2013/04/Campbell_WHITEPOINTSLIDES.pdf
Centers for Medicare & Medicaid Services. (2015). Medicare.gov: Hospital compare: Hospital
results: Survey of patients experiences. Retrieved October 1, 2015, from
https://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&cmprID=490059
%2C490069%2C490136&cmprDist=40.2%2C43.1%2C44.8&dist=50&lat=37.9598456&
lng=-77.8595963&loc=23117
Corwin, D. J., Kessler, D. O., Auerbach, M., Liang, A., & Kristinsson, G. (2012). An intervention
to improve pain management in the pediatric emergency department. Pediatric
Emergency Care, 28(6), 524-528. Retrieved from http://ovidsp.uk.ovid.com/sp3.17.0a/ovidweb.cgi?
WebLinkFrameset=1&S=AOOHPDEBMGHFCPPJFNJKBGCGBBCDAA00&returnUrl
=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.22.23%257c0%257c00006565201206000-00009%26S
%3dAOOHPDEBMGHFCPPJFNJKBGCGBBCDAA00&directlink=http%3a%2f
%2fgraphics.uk.ovid.com%2fovftpdfs%2fPDHFFNCGBGPJMG00%2ffs046%2fovft
%2flive%2fgv025%2f00006565%2f00006565-20120600000009.pdf&filename=An+Intervention+to+Improve+Pain+Management+in+the+Pediatri
c+Emergency+Department.&pdf_key=PDHFFNCGBGPJMG00&pdf_index=/fs046/ovft/
live/gv025/00006565/00006565-201206000-00009

PAIN REASSESSMENT IN PEDIATRIC PATIENTS

Hospital Consumer Assessment of Healthcare Providers and Systems. (2015). HCAHPS Survey.
Retrieved from http://www.hcahpsonline.org/files/HCAHPS%20V10.0%20Appendix
%20A%20-%20HCAHPS%20Mail%20Survey%20Materials%20(English)%20March
%202015.pdf
Kellogg, K. M., Fairbanks, R. J., OConnor, A. B., Davis, C. O., & Shah, M. N. (2012).
Association of pain score documentation and analgesic use in a pediatric emergency
department. Pediatric Emergency Care, 28(12), 1287-1292. Retrieved from
http://ovidsp.uk.ovid.com/sp-3.17.0a/ovidweb.cgi?
WebLinkFrameset=1&S=AOOHPDEBMGHFCPPJFNJKBGCGBBCDAA00&returnUrl
=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.27.28%257c0%257c00006565201212000-00006%26S
%3dAOOHPDEBMGHFCPPJFNJKBGCGBBCDAA00&directlink=http%3a%2f
%2fgraphics.uk.ovid.com%2fovftpdfs%2fPDHFFNCGBGPJMG00%2ffs047%2fovft
%2flive%2fgv024%2f00006565%2f00006565-20121200000006.pdf&filename=Association+of+Pain+Score+Documentation+and+Analgesic+Use
+in+a+Pediatric+Emergency+Department.&pdf_key=PDHFFNCGBGPJMG00&pdf_ind
ex=/fs047/ovft/live/gv024/00006565/00006565-201212000-00006

PAIN REASSESSMENT IN PEDIATRIC PATIENTS

Equipment
Lack of flagging within Connect Care in
respect to pediatric pain scales

Environment

High census

Insufficient number of WOWs

for each room
Policy that requires reassessment of
pain within the hour of previous
pain report greater than 3 and/or
implementation of interventions

Policy/Procedures

Lack of knowledge
Lack of staff

Personnel

Pain reassessments
are not completed
within the hour of
previous pain
report greater than
3 and/or
implementation of
interventions