title: Introducing LAPPS (Liverpool Anticipatory Procedural Pain Score): the pragmatic development of an innovative approach to predicting and treating procedural pain and distress in children.
abstract: Removal of chest drains is a painful procedure and distresses patients, parents and nurses. To identify problems and improve management we developed a concerted approach to both assessment and treatment using audit. An initial prospective audit of post-op cardiac children undergoing chest drain +/- pacing wire removal was undertaken. A clinical tool was developed, to assess children before procedures and provide a treatment plan aimed at reducing pain and distress. The tool incorporated the intensity of the procedure, the child's usual response to procedures and previous experience. The treatment protocol included drug and non-drug therapies. The initial audit of 91 children confirmed that pain and distress were problems. It highlighted inconsistencies in management as a common feature. Following introduction of the LAPPS tool and treatment protocol, a second audit of 72 children was undertaken. Although only 46 per cent of pathways were satisfactorily completed, the percentage of patients described as 'inconsolable, screaming and withdrawn' reduced from 29 per cent to 9 per cent. Introduction of the LAPPS assessment tool and treatment protocol reduced pain and distress during removal of chest drains. Research is needed to test the psychometrics of the tool and the effectiveness of the treatment protocol prior to wider use.
authors.affiliation: Department of Anaesthesia, Alder Hey Children's NHS Foundation Trust Pain Control Service, UK. jennie.craske@alderhey.nhs.uk
authors.forename: Jennie
authors.initials: J
authors.lastname: Craske
authors.forename: Fran
authors.initials: F
authors.lastname: Dooley
authors.forename: Linda
authors.initials: L
authors.lastname: Griffiths
authors.forename: Liz
authors.initials: L
authors.lastname: McArthur
authors.forename: Elvina
authors.initials: E
authors.lastname: White
authors.forename: Mary
authors.initials: M
authors.lastname: Cunliffe
mesh_terms: D000700:Analgesics / Q000008:administration & dosage; D015505:Chest Tubes; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007223:Infant; D008485:Medical Audit; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000295:instrumentation*; D011446:Prospective Studies
chemical_list: D000700:Analgesics
keywords: Audit; paediatric; pain