title: A paradigm shift to balance safety and quality in pediatric pain management.
abstract: OBJECTIVE
  Undertreating pain and inappropriate use of opioids are potentially harmful to patients. We created a reliable process to discuss the pain plan preoperatively, hypothesizing that it will enhance the safety of opioid administration while improving the quality of pain management.
  
  
  METHODS
  A multidisciplinary group was convened for a 3-day workshop where a reliable method for preoperative discussion of the pain plan was created for patients having ambulatory hernia repair. Four targets were defined: (1) pain management is discussed by the provider; (2) a pain plan is accurately documented in the electronic medical record; (3) parents perceive that pain is adequately discussed; and (4) behavioral indicators demonstrate the pain plan is effective. The goal was 100% compliance with targets at 60 days. A standard pain regimen was created. Data collection included chart review and a postoperative phone call. Patients were separated into 30-day postimplementation cohorts for evaluation of their hernia. Analysis was descriptive.
  
  
  RESULTS
  A total of 235 patients had hernia repair. Discussion and documentation of pain occurred in 73% at 240 days (n = 15). Providers entered orders for postoperative pain in 80% at 240 days after implementation. Parents reported that pain was adequately discussed and treated between 87% and 100% of the time.
  
  
  CONCLUSIONS
  Balancing the potential harm from undertreating pain and inappropriate use of opioids requires an evidence-based, multidisciplinary family-centered approach. The development and implementation of a reliable method for the management and treatment of pain reduces variability allowing for delivery of safe and quality care.
authors: Department of Surgery, University of Washington, Division of Surgery, Seattle Children's Hospital, Seattle, WA 98105-0371, USA. jeffrey.avansino@seattlechildrens.org
authors: Jeffrey R
authors: JR
authors: Avansino
authors: Lisa M
authors: LM
authors: Peters
authors: Shellie L
authors: SL
authors: Stockfish
authors: Gary A
authors: GA
authors: Walco
mesh_terms: D004493:Education / Q000379:methods / Q000592:standards; D006801:Humans; D033183:Interdisciplinary Communication; D059408:Pain Management / Q000379:methods / Q000592:standards*; D010149:Postoperative Pain / Q000517:prevention & control / Q000628:therapy*; D010348:Patient Care Team / Q000592:standards*; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards*; D061214:Patient Safety / Q000592:standards*; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000592:standards*