May 11, 2022
Safely and effectively managing pain in our pediatric patients is a primary responsibility for our EMS clinicians. Medical directors must be able to identify gaps in pediatric pain management and provide the necessary QA/QI to close those gaps. In this episode we focus on exactly that, with several experts in EMS joining us to offer their knowledge and critical appraisal of the evidence in order to identify and close the gaps in the management of pain in children.
Brought to you by:
Dr. Joelle Donofrio-Odmann and Dr. Joseph Finney
Take Home Points
Medical Directors can
utilize QA/QI to improve management of pediatric pain within their
EMS systems. Protocols for managing pediatric pain benefit from
mirroring the most current evidence. This podcast provides
information on how to develop protocols, what QA/QI to consider,
the current evidence to optimize your ouch-less EMS agency, and how
to use your tertiary Children’s hospital to help. Below are all the
tools you need to make your agency “ouch-less”.
The NASEMSO Model Guidelines are also a great option to help guide protocol development (link below).
DON’T WAIT TO TREAT PAIN!
We also recommend utilizing the EIIC Pain management resources available at the link below. The EIIC has educational resources, tools, and recommendations for improving pediatric pain management.
Literature Review Recap
Analgesia Use in Children with Acute Long Bone Fractures in the Pediatric Emergency Department. Published in The Journal of Emergency Medicine in 2020
Where: Assessment of the management of pediatric pain in a tertiary children’s hospital emergency department in the setting of long bone fractures.
What: Retrospective single center study
Who: Age 18yo and younger with ED diagnosis of long bone fracture, 2005-2016
Implications: Even in the ED, we don’t do a very good job of quickly treating pain or even treating it at all.
Consider standing orders for managing pain in certain situations such as long bone fractures.
Prehospital Pain Management: Disparity By Age and Race published in Prehospital Emergency Care in 2018
Where: Research data set
What: Retrospective descriptive study from 2012-2014
Who: Patients <18yo captured in the database
Implications: There is likely bias leading to disparities in the management of pain prehospital both by age and race.
Consider establishing protocols for pain management especially in our youngest patients. QA and QI focused on bias in prehospital medicine is critical for medical directors.
Multicenter Evaluation of Prehospital Opioid Pain Management in Injured Children published in Prehospital Emergency Care in 2016
Objective: Assess the change in frequency of pain documentation and the change in frequency of opioid administration in kids with injuries after applying evidence-based guidelines
Where: 3 separate EMS agencies, part of CHAMP research node of PECARN
Who: <18yo prehospital patients with blunt, penetrating, laceration, and/or burn trauma
What: Updated pain protocols and implemented mandatory CE
Implications: Implementation of protocol changes alone does not translate to clinical practice change. If you make changes “you really have to own it”
Consider adding quality improvement projects to improve adherence to protocol changes. Robust QA/QI is a must for any medical director. Measuring an intervention over time before deciding if they worked or not helps to avoid false results during the "washout period". Consider an EMR prompt to encourage assessing and treating pain.
Evidence-Based Guidelines for Prehospital Pain Management: Recommendations published in Prehospital Emergency Care in 2021
Objective: Provide evidence-based guidelines for the management of pain prehospital in adults and pediatrics
What: RECENT Systematic review of the comparative effectiveness of analgesics in the prehospital setting prepared by the University of Connecticut Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ) with funding by NIHTSA.
(Mostly) Pediatric-focused Recommendations
Implications: Follow evidence-based guidelines when developing your pediatric pain management protocols
The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit https://emscimprovement.center
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