The impact of educational intervention programs on pain management in a pediatric emergency department.
Management of pain and anxiety is an important part of patient care in the pediatric emergency department (ED). Even though it has improved significantly over the past few years, it is still suboptimal. The objective of this study was to evaluate the effect of informal and formal education on pain and anxiety management in the pediatric ED. Management of pain and anxiety was assessed by comparing the use of analgesics and sedatives during three phases: A) year 2000 (baseline), B) years 2001-2002 (informal teaching) and C) year 2004 (following a structured simulation-based training in pediatric sedation and analgesia). During period B there was a significant increase in the yearly use of eutectic mixture of local anesthetics (EMLA) (RR=2.63, CI 1.23-5.6), ibuprofen (RR=14.16, CI 8.73-22.98), midazolam (RR=1.68, CI 1.39-2.03) and nitrous oxide (N2O) in comparison with period A, with an additional increment of the first three medicines during period C. There was no change in the use of ketamine, morphine and meperidine during period B. Whereas, during period C, a significant increase in the use of ketamine and morphine was demonstrated (RR=24.56, CI 10.71-56.3 and RR=3.07, CI 2.12-4.44, respectively), while the use of meperidine (RR=0.68, CI 0.49-0.94) and N2O (RR=0.46, 95% CI 0.32-0.67) declined significantly. Educational interventions have a clear impact on pain and anxiety management demonstrated by the subsequent change in the use of sedatives and analgesics and should be provided to pediatric ED physicians. Informal teaching affected mainly the use of milder sedatives and analgesics, while formal structured training influenced the use of opioids and dissociative agents.
Augarten
Arie
A
Department of Pediatric Emergency Medicine, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, and Emergency Department, Meyer Children's Hospital, Rambam Medical Center, Haifa, Israel. augarten@post.tau.ac.il
Zaslansky
Ruth
R
Matok Pharm
Ilan
I
Minuskin
Tal
T
Lerner-Geva
Liat
L
Hirsh-Yechezkel
Galit
G
Ziv
Amitai
A
Shavit
Itai
I
Yativ
Nir
N
Keidan
Ilan
I
D000700:Analgesics / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy*; D004363:Drug Utilization; D004501:Education, Medical; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D010146:Pain / Q000188:drug therapy*; D010372:Pediatrics / Q000592:standards*; D015397:Program Evaluation; D011446:Prospective Studies; D013997:Time Factors
D000700:Analgesics; D014151:Anti-Anxiety Agents