title: Multiple interventions improve analgesic treatment of supracondylar humerus fractures in a pediatric emergency department.
abstract: BACKGROUND
  Provision of appropriate and timely treatment for pain in the pediatric population has been challenging. Children with painful conditions commonly present to emergency departments (EDs), a setting in which it may be particularly difficult to consistently provide timely analgesic interventions.
  
  
  OBJECTIVE
  To measure the effectiveness of a set of interventions in improving the rate and timeliness of analgesic medication administration, as well as appropriate backslab immobilization (application of a moldable plaster or fiberglass splint), in a pediatric ED.
  
  
  METHODS
  Data regarding pain management were collected on a consecutive sample of cases of supracondylar fracture over a 13-month period. This followed the implementation of a formal triage pain assessment and treatment medical directive, supplemented with relevant education of nursing and house staff, and posters in the ED. These data were compared with data previously collected from a similar cohort of cases, which presented before the interventions.
  
  
  RESULTS
  Postintervention, the proportion of patients treated with an analgesic within 60 min of triage increased from 15% to 54% (P<0.001), and the median time to administration of an analgesic decreased from 72.5&nbsp;min to 11 min (P<0.001). Rates for backslab application before radiography were similar before and after the intervention (29% and 33%, respectively; P=0.646).
  
  
  CONCLUSIONS
  A multifaceted approach to improving early analgesic interventions was associated with considerably improved rates of early analgesic treatments for supracondylar fracture; however, no improvement in early immobilization was observed.
authors.forename: Robert Neil
authors.initials: RN
authors.lastname: Porter
authors.forename: Roger E
authors.initials: RE
authors.lastname: Chafe
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Newhook
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Murnaghan
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006776:Hospitals, Pediatric; D006801:Humans; D006811:Humerus / Q000293:injuries*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D059408:Pain Management; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics