title: Making Comfort Count: Using Quality Improvement to Promote Pediatric Procedural Pain Management.
abstract: OBJECTIVE
  Pediatric procedural pain management (PPPM) is best practice but was inconsistent in our large multisite general academic medical center. We hypothesized that quality improvement (QI) methods would improve and standardize PPPM in our health system within inpatient pediatric units. We aimed to increase topical anesthetic use from 10% to 40%, improve nursing pediatric pain knowledge, and increase parent satisfaction around procedures for children admitted to a general tertiary academic medical center.
  
  
  METHODS
  We used QI methods including needs assessment, self-identified champions, small tests of change, leadership accountability, data transparency, and a train-the-peer-trainer approach to implement PPPM. We measured inpatient use of topical anesthetic (goal of 40% of admissions), nursing pain knowledge, and parent satisfaction with child comfort during procedures. We used statistical process control and basic statistics to analyze data in this interrupted time series design.
  
  
  RESULTS
  Over 18 months, use of topical lidocaine rose from 10% to 36.5% for all inpatient admissions, resulting in a centerline shift. Nursing pain knowledge scores increased 7%. Mean parent satisfaction around procedural comfort increased from 83% to 88%.
  
  
  CONCLUSIONS
  A child-focused QI initiative around PPPM can succeed in a multisite general academic medical center. Key success factors for this effort included accountability, multidisciplinary core leadership, housewide training in a novel educational evidence-based framework, and use of data and champions to promote nurse and physician engagement. Future work will focus on sustaining and monitoring change.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, New York; NYU Langone Medical Center, New York, New York; rebecca.rosenberg@nyumc.org.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Rosenberg
authors.affiliation: Department of Pharmacy, Westchester Medical Center, Valhalla, New York;
authors.forename: Liana
authors.initials: L
authors.lastname: Klejmont
authors.affiliation: St. Luke's Medical Center, New York, New York; and.
authors.forename: Meghan
authors.initials: M
authors.lastname: Gallen
authors.affiliation: NYU Langone Medical Center, New York, New York;
authors.forename: Jackie
authors.initials: J
authors.lastname: Fuller
authors.affiliation: NYU Langone Medical Center, New York, New York;
authors.forename: Christina
authors.initials: C
authors.lastname: Dugan
authors.affiliation: NYU Langone Medical Center, New York, New York; New York University School of Nursing, New York, New York.
authors.forename: Wendy
authors.initials: W
authors.lastname: Budin
authors.affiliation: NYU Langone Medical Center, New York, New York;
authors.forename: Ingrid
authors.initials: I
authors.lastname: Olsen-Gallagher
mesh_terms: D000279:Administration, Cutaneous; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002648:Child; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D007297:Inpatients; D065186:Interrupted Time Series Analysis; D008012:Lidocaine / Q000008:administration & dosage*; D020380:Needs Assessment; D024802:Nurse's Role; D010146:Pain / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control; D059408:Pain Management / Q000451:nursing; D010290:Parents; D017060:Patient Satisfaction; D010372:Pediatrics; D058996:Quality Improvement; D011795:Surveys and Questionnaires
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine