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									      James Paget University Hospitals
      NHS Foundation Trust
2008 Paediatric Post-Operative Pain Re-audit

Ally Davison – Neonatal & Paediatric Practice Development Nurse
Rachael Smith – Staff Nurse


        Facilitated by: The Clinical Audit & Effectiveness Department, JPUH



                                                          Working Together
                                                          for Excellent Care
Introduction:


• Objectives:
  – To ensure documentation is completed on
    pain assessment.


• Rationale:
  – To improve service, also for record keeping
    and accountability.
Age of patient:


• Range:            • Median:
  – 2 to 17 years     – 9.5 years




• Average:          • Mode:
  – 9.6 years         – 13 years
Speciality:


• ENT:               • Gynaecology:
  – 35% (7/20)         – 5% (1/20)




• General surgery:   • Orthopaedic:
  – 30% (6/20)         – 30% (6/20)
Surgical procedure:
•   Appendicectomy:                           •   MUA:
     –   15% (3/20)                                –   5% (1/20)
•   Bilateral & lateral nail fold excision:   •   MUA # nose:
     –   5% (1/20)                                 –   5% (1/20)
•   Bilateral grommets & adenoidectomy:       •   MUA of arm:
     –   5% (1/20)                                 –   5% (1/20)
•   EUA both ears removal of foreign          •   MUA of left wrist:
    body:                                          –   5% (1/20)
     –   5% (1/20)                            •   Not answered:
•   EUA of finger nail sutured:                    –   5% (1/20)
     –   5% (1/20)                            •   Removal of earring from ear buried in:
•   Exploration hand:                              –   5% (1/20)
     –   5% (1/20)                            •   Tonsillectomy & dental extractions:
•   Exploration scrotum:                           –   5% (1/20)
     –   5% (1/20)                            •   TOP:
•   Grommets:                                      –   5% (1/20)
     –   5% (1/20)                            •   Wound debridement & suturing:
•   Left pyeloplasty & left kidney stone:          –   5% (1/20)
     –   5% (1/20)
The patient will have analgesia prescribed according to the
Paediatric Post-Op Pain Guidelines, before returning to the
ward from theatre / recovery.



                 50%                                  50%




     Met (10)                           Exception: Allergy (0)
     Exception: Contra-indication (0)   Failed (10)
Nursing staff will record patient’s pain score within notes
upon returning to the ward.




                   50%                       50%




                         Met (10)   Failed (10)
Nursing staff will record patient’s pain score on front of
observation chart at least every 4 hours.




                 55%                            45%




                        Met (9)   Failed (11)
Nursing staff will record evaluation of pain management on
reverse of observation chart.



                                        15%

                 55%                          30%




    Met (3)   Exception: No pain management required (6)   Failed (11)
Conclusions:

• It is apparent that there is still training
  required for the assessment and
  prescribing of post op analgesia in
  children.
• Although staff may be good at
  administering analgesia ,documentation
  needs to be improved with the assessing,
  evaluating and recording of pain scores.
Recommendations:
• Review of post operative analgesia guidelines
• Review of assessment tools used in paediatrics
  and implementation of possible new assessment
  tools
• Revision and implementation of updated post
  operative analgesia ladder
• In house training prior to re-launching of
  changes listed above
• Re audit six months after changed implemented.

								
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