Pain management practices in paediatric emergency departments in Australia and New Zealand: a clinical and organizational audit by National Health and Medical Research Council's National Institute of Clinical Studies and Paediatric Research in Emergency Departments International Collaborative.
OBJECTIVE
To audit pain management practices and organization in paediatric ED across Australia and New Zealand.


METHODS
Retrospective audit of pain management practices in Paediatric Research in Emergency Departments International Collaborative ED in 20 cases each of migraine, abdominal pain and femoral shaft fracture. Review of organizational status of pain management at Paediatric Research in Emergency Departments International Collaborative sites.


RESULTS
Of 14 ED, 10 participated in the clinical audit. A total of 196 migraine, 197 abdominal pain and 177 femur fracture cases were reviewed. Less than half had degree of pain measured or had pain score documented on triage. Migraine received analgesia in 62% of cases (opioids in 11%). Abdominal pain received analgesia in 62% of cases (opioids in 14%). Fractured femurs received analgesia in 78% of cases (opioids 49%, femoral nerve blocks 40%). Median minutes to enteral medication were 100, 85 and 75, and for parenteral medication (mainly opiates) 103, 137 and 26, for migraine, abdominal pain and femur fracture, respectively. Thirteen hospitals participated in the organizational audit. Of all ED, 92% had pain management policies or guidelines, 92% taught pain management topics in education programmes and 62% used mandatory pain competencies. Only 15% had quality improvement programmes for pain reduction.


CONCLUSIONS
We found a notable lack of pain assessment documentation and delays to analgesia. There is a need to improve pain assessment and management, although a majority of paediatric ED surveyed had important organizational and educational structures in place. Issues to explore include use of opioids in migraine and the underuse of femoral nerve blocks.
Herd
David W
DW
Paediatric Research in Emergency Departments International Collaborative, Australia and New Zealand.
Babl
Franz E
FE
Gilhotra
Yuri
Y
Huckson
Sue
S
D015746:Abdominal Pain / Q000628:therapy*; D000700:Analgesics / Q000008:administration & dosage; D001315:Australia; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005264:Femoral Fractures / Q000150:complications*; D006801:Humans; D008485:Medical Audit; D008881:Migraine Disorders / Q000628:therapy*; D009520:New Zealand; D059408:Pain Management; D010147:Pain Measurement; D010353:Patient Education as Topic; D010372:Pediatrics / Q000379:methods*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage
D000700:Analgesics