title: Optimizing the assessment of pain in children who are cognitively impaired through the quality improvement process.
abstract: Pain assessment in children with cognitive impairment (CI) is challenging. A quality improvement (QI) project involving evidence-based review of pain assessment tools, feedback from the Family Advisory Council, trialing of selected tools within clinical settings including obtaining feedback from nurses, and parents caring for nonverbal children with developmental delay was reported. Synthesized evidence supported the adoption of revised Faces, Legs, Activity, Cry, and Consolability pain assessment tool into clinical practice. Results of postimplementation audit and challenges of staff nurse involvement in the QI process were also discussed. The 24-month-long QI process and its impact on changing practice were described in detail.
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA, USA. chenlim@email.chop.edu
authors.forename: Mei Lin
authors.initials: ML
authors.lastname: Chen-Lim
authors.forename: Colleen
authors.initials: C
authors.lastname: Zarnowsky
authors.forename: Renee
authors.initials: R
authors.lastname: Green
authors.forename: Susan
authors.initials: S
authors.lastname: Shaffer
authors.forename: Brenda
authors.initials: B
authors.lastname: Holtzer
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ely
mesh_terms: D002648:Child; D002652:Child Behavior / Q000502:physiology*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D003448:Crying / Q000502:physiology; D002658:Developmental Disabilities / Q000453:epidemiology / Q000503:physiopathology; D055318:Evidence-Based Nursing; D005149:Facial Expression; D005260:Female; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000502:physiology; D008297:Male; D009068:Movement / Q000502:physiology; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods* / Q000451:nursing; D010371:Pediatric Nursing / Q000193:education; D058996:Quality Improvement