Critical Care Plus: Techniques for Reducing Pain in the PICU Boston Medical program seeks full protocols and compliance
May 1, 2002 2 minutes read
Critical Care Plus: Techniques for Reducing Pain in the PICU Boston Medical program seeks full protocols and compliance
By Julie Crawshaw, CRC Plus Editor
The Painfree Pediatrics Program at Boston Medical Center aims to make pain management a fundamental component of pediatric care, educating patients, families, and medical staff in the process. According to Scot Bateman, MD, who directs the PICU at Boston Children’s Hospital, the program is making major changes in the way pediatric critical care is practiced. "What’s nice about this push for pain-free pediatric care is it’s changing our mentality about all procedures," Bateman says.
Procedural pain, of course, is a part of both routine and acute health care encounters. But assessing the level of a kid’s pain can be difficult. Bateman says BMC’s nurses and residents now rethink how to best perform pain control from early on, seeking to understand how patients experience pain through getting more pre-procedural information about patient coping mechanisms through parental interviews. That information is then incorporated into both nonpharmocologic and pharmocologic pain control measures.
Good Assessment Scales Integral to Lessen Pain
Correctly assessing the PICU patient’s level of pain can be tough. Pediatric patients usually can’t answer "on a scale of 1-to-10" type questions, so Bateman and his colleagues rely on the two age-appropriate pain assessment scales on pages 22-23. Table 1 is the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS), and Table 2 is the Riley Infant Pain Scale.
Bateman’s group has also written a set of protocols (see Table 3) for nonpharmacological pain interventions, which are noninvasive strategies he says increase comfort, improve coping, and give children a sense of control. "Either alone or in conjunction with pain medication, these strategies are proven successful for the reduction of pain and the associated anxiety," Bateman says. "They promote parental involvement and are very safe and easily accessible by all members of the health care team."
Finally, the PainFree group has created a systematic approach to administering analgesics that uses a checklist of different medications useful for different procedures like the nurse-driven protocol. (See Table 4.)
Whether the procedure is putting in central lines or chest tubes for intubation, Bateman says all members of his PICU care team focus on making it as pain free as possible. "It requires a concerted, conscious effort to think about how to do procedures in the least painful way every time," Bateman says, "We want to make sure that every arterial line that’s done in our hospital follows the pediatric pain-free protocols." To obtain a copy of the PainFreeguideline.doc, please contact Bateman at the e-mail below.
(For more information contact Scot Bateman, MD, at [617] 355-7327 or e-mail him at [email protected].)
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