title: Toward Better Pain Management: The Development of a "Pain Stewardship Program" in a Tertiary Children's Hospital.
abstract: Despite increased focus on pediatric pain, uncontrolled pain is still a problem for hospitalized pediatric inpatients. A program was designed to find patients with uncontrolled pain and develop a framework to oversee their pain management. This report details the development of a pain stewardship program with data from the first year of its activity.
  
  
  
  Hospitalized inpatients in a tertiary care pediatric center in the mid-Atlantic region were included in the study. Pain scores are recorded every 4 hours in the hospital electronic health record. A report was constructed to find all patients with an average pain score ≥7 in the preceding 12 hours. The charts of these patients were reviewed by our anesthesia pain service, and all patients were grouped into 1 of the following action categories: (1) no action required; (2) telephone call to the patient's attending physician; (3) one-time consultation; (4) consultation with ongoing management; or (5) patient was already on the anesthesia pain service. Demographic data, pain regimens, and outcomes were recorded in a prospectively collected database.
  
  
  
  There were 843 records on 441 unique patients. Only 22% required action to be taken by the anesthesia pain service. The pain stewardship database revealed that patients with sickle cell disease or abdominal pain required more frequent attention.
  
  
  
  An electronic health record-based pain stewardship program is an important step in identifying all children in the hospital with undermanaged pain, and it provides a warning system that may improve patient care, outcomes, and satisfaction.
authors: Department of Anesthesia and Perioperative Medicine, brbrenn@nemours.org.
authors: B Randall
authors: BR
authors: Brenn
authors: Department of Anesthesia and Perioperative Medicine.
authors: Dinesh K
authors: DK
authors: Choudhry
authors: Department of Nursing, and.
authors: Karen
authors: K
authors: Sacks
authors: Department of Nursing, and.
authors: Sandra
authors: S
authors: Como-Fluehr
authors: Nemours Health Informatics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.
authors: Robert
authors: R
authors: Strain
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D059408:Pain Management / Q000592:standards*; D016730:Program Development; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care; D062606:Tertiary Care Centers; D055815:Young Adult