title: Improvements in pain outcomes in a Canadian pediatric teaching hospital following implementation of a multifaceted knowledge translation initiative.
abstract: BACKGROUND
  A previous audit performed at a tertiary ⁄ quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children's pain. Knowledge translation (KT) initiatives (education, reminders, audit and feedback) were implemented to address identified care gaps; however, the impact is unknown.
  
  
  OBJECTIVE
  To determine the impact of KT initiatives on pain outcomes including process outcomes (eg, pain assessment and management practices) and clinical outcomes (eg, pain prevalence and intensity); and to benchmark additional pain practices, particularly opioid administration and painful procedures.
  
  
  METHODS
  Medical records at The Hospital for Sick Children (Toronto, Ontario) were reviewed on a single day in September 2007. Pain assessment and management practices, and pain prevalence and intensity in the preceding 24 h were recorded on a standardized data collection form. Where possible, pain outcomes were compared with previous audit results.
  
  
  RESULTS
  Records of 265 inpatients were audited. Sixty-three per cent of children underwent a documented pain assessment compared with 27% in an audit conducted previously (P<0.01). Eighty-three per cent of children with documented pain received at least one pain management intervention. Overall, 51% of children received pharmacological therapy, and 15% received either a psychological or physical pain-relieving intervention. Of those assessed, 44% experienced pain in the previous 24 h versus 66% in the previous audit (P<0.01). Fewer children experienced severe pain compared with the first audit (8.7% versus 26.1%; P<0.01). One-third of children received opioids; 19% of these had no recorded pain assessment. Among 131 children who underwent a painful procedure, 21% had a concurrent pain assessment. Painful procedures were accompanied by a pain-relieving intervention in 12.5% of cases.
  
  
  CONCLUSIONS
  Following KT initiatives, significant improvements in pain processes (pain assessment documentation and pain management interventions) and clinical outcomes (pain prevalence, pain intensity) were observed. Further improvements are recommended, specifically with respect to procedural pain practices and opioid utilization patterns.
authors.affiliation: Department of Pharmacy, Sunnybrook Health Sciences Center, Canada.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Zhu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stinson
authors.forename: Lori
authors.initials: L
authors.lastname: Palozzi
authors.forename: Kevin
authors.initials: K
authors.lastname: Weingarten
authors.forename: Mary-Ellen
authors.initials: ME
authors.lastname: Hogan
authors.forename: Silvia
authors.initials: S
authors.lastname: Duong
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
authors.forename: Fiona A
authors.initials: FA
authors.lastname: Campbell
authors.forename: Anna
authors.initials: A
authors.lastname: Taddio
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D019359:Knowledge; D008297:Male; D010146:Pain / Q000453:epidemiology*; D059408:Pain Management; D010147:Pain Measurement; D014177:Translations