title: Protocolized post-operative pain management in infants; do we stick to it?
abstract: BACKGROUND
  The American Academy of Pediatrics states that ongoing assessment of pain is essential for adequate pain treatment. Pain assessment by means of the COMFORT behaviour scale and the Numeric Rating Scale is therefore an important component of the post-operative pain treatment protocol for neonates and infants in our intensive care unit (ICU).
  
  
  OBJECTIVE
  The study aims to determine degrees of staff compliance with this protocol.
  
  
  METHODS
  This retrospective chart review concerned post-surgical patients under the age of 3 years admitted to our level III ICU over a 1-year period. The degree of compliance to the post-operative pain protocol was measured by the frequency of deviations from protocol-dictated drug treatment and pain assessments.
  
  
  RESULTS
  Records of 200 children with a median age at surgery of 98 days (interquartile range 6-320) were analysed. A mean of 11 assessments in the first 72  h post-operatively per patient had been recorded. A total of 2103 pain assessments were retrieved, of which 1675 (79.7%) suggested comfort. Compliance to the protocol (reassessment and correct medication) was provided in 66 (15.4%) of the 428 assessments suggesting pain or distress.
  
  
  CONCLUSIONS
  The post-operative pain protocol applied in our ICU appears to be effective; however, full compliance to the protocol was marginal, possibly leading to under-treatment of pain.
authors.affiliation: Department of Pediatric Surgery & Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Ceelie
authors.forename: S N
authors.initials: SN
authors.lastname: de Wildt
authors.forename: M
authors.initials: M
authors.lastname: de Jong
authors.forename: E
authors.initials: E
authors.lastname: Ista
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.forename: M
authors.initials: M
authors.lastname: van Dijk
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies