Post-operative pain: the impact of prescribing patterns on nurses' administration of analgesia.
In the past 30 years, significant improvements have been made in the management of children's pain, with most children receiving analgesia post-operatively. However, the amount of analgesia administered to children after surgery varies depending on a number of factors.


OBJECTIVE
To measure the difference between what children are prescribed for analgesia post-operatively and what they are administered in the first 24 hours following surgery and to explore the influence of the analgesic being prescribed 'as required' or regularly.


METHODS
A retrospective chart review of 175 children was carried out at a children's hospital and a paediatric unit in a large teaching hospital. The analgesics that were administered in the first 24 hours post-surgery were morphine, codeine, diclofenac, ibuprofen and paracetamol.


RESULTS
Each analgesic that was prescribed was administered in decreasing amounts relative to the strength of the analgesic. The highest percentage given was of paracetamol. When the prescription was for regular paracetamol, it was administered by nurses 88 per cent of the time, whereas when it was prescribed on a pro re nata (prn) or as required basis, 77 per cent of prescribed paracetamol was given. When analgesics were prescribed regularly, children had a considerably greater chance of receiving the analgesic.


CONCLUSIONS
Nurses need to be more responsive to children in pain and acknowledge the value of prn prescribing of analgesics for children post-operatively. There is a need to increase nurses' confidence in assessing and responding to children's pain.
Simons
Joan
J
Faculty of Health and Human Sciences, Thames Valley University.
Moseley
Laurence
L
D000082:Acetaminophen / Q000627:therapeutic use; D000698:Analgesia / Q000379:methods / Q000451:nursing / Q000706:statistics & numerical data; D000700:Analgesics / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D003061:Codeine / Q000627:therapeutic use; D004008:Diclofenac / Q000627:therapeutic use; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000451:nursing / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006784:Hospitals, Teaching; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D009730:Nursing Assessment; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000451:nursing*; D011182:Postoperative Care / Q000451:nursing / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D000082:Acetaminophen; D003061:Codeine; D007052:Ibuprofen