title: A mixed-method study of pain management practice in a UK children's hospital: identification of barriers and developing strategies to maintain effective in-patient paediatric pain management.
abstract: OBJECTIVE
  To assess Acute Pain Service and paediatric pain management efficacy in a UK specialist paediatric hospital to inform wider recommendations for future sustainability.
  
  
  BACKGROUND
  UK paediatric acute pain services vary. Although comprehensive pain management guidelines exist, consensus on the best model of care is lacking. Worldwide, medical and pharmacological advances and rapid patient turnover have increased the challenges of managing hospitalized children's pain. Simultaneously nurses, who deliver the bulk of pain management, have experienced reduction in skill mix and training opportunities. Specialist Acute Pain Services have evolved to meet these demands; their overall efficacy is unknown.
  
  
  METHODS
  This mixed-methods study explores pain management practice at a UK paediatric hospital to assess current efficacy and future sustainability.
  
  
  METHODS
  A 2013 case note review of all Acute Pain Services referrals over 14 days were compared with an interval sample of concurrent non-referred inpatient children; seven semi-structured interviews were conducted with a range of clinical staff.
  
  
  RESULTS
  Twenty-two referrals of 15 children were made; 15 comparison children were identified. All 30 children (100%) were appropriately referred/non-referred. Acute Pain Services cases experienced higher pain levels, were more likely to have long term conditions, longer hospital stay and repeat admissions. Three key themes emerged through interview analysis: 'addressing pain', 'changing contexts' 'pain as an "expert" skill'. Increased specialization, reduced clarity between different pain modalities and decreased training opportunities had resulted in potentially unsustainable APS dependence.
authors.affiliation: Faculty of Health & Life Sciences University of the West of England, Bristol Bristol UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Beckett
authors.affiliation: Louis Dundas Centre for Children's Palliative Care Institute of Child Health University College London London UK.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Henderson
authors.affiliation: Acute Pain Service United Hospitals Bristol NHS Foundation Trust Bristol UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Parry
authors.affiliation: Acute Pain Service United Hospitals Bristol NHS Foundation Trust & University of Bristol Bristol UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Stoddart
authors.affiliation: Faculty of Health & Life Sciences University of the West of England, Bristol & University Hospitals Bristol NHS Foundation Trust Bristol UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fletcher
keywords: efficacy; hospital; inpatient; nursing; pain; pain management; pain service; post surgical