Pediatric Pain Assessment in the Intensive Care Unit: An Evidence-Based Algorithm

BackgroundConducting an adequate pain assessment in the Pediatric Intensive Care Unit (PICU) is multifactorial and complex due to the diversity of the population. It is critical that validated pain assessment methods are used appropriately and consistently to aid in evaluation of pain and pain management interventions.PurposeThe aim of this evidence-based practice project was to improve pain assessment practices in the PICU through a decision-support algorithm.Design & MethodsThe Iowa Model-Revised was used to guide the development and implementation of an evidence-based decision algorithm. Pre- and postdata were collected via surveys (nursing knowledge and confidence) and documentation audits (nursing pain assessments). Various implementation strategies were used to facilitate the integration and sustainability of the algorithm in practice.ResultsThe majority of survey items showed an increase in nursing knowledge and confidence. Audits of pain assessment documentation displayed an increase in appropriate pain assessment documentation related to a child's communicative ability. However, there is a need for reinfusion related to the documentation of sedation assessments.ConclusionsThe use of an algorithm supported the ability of PICU nurses to critically consider and choose the pain assessment method most appropriate for the patient's condition. The algorithm promotes nursing clinical judgement, prioritizes pain management, and includes patients receiving sedation. The algorithm supports a comprehensive pain assessment in a difficult pediatric patient population. Future research is needed to strengthen and standardize the usage of terms “assume pain present” and “assume pain managed,” and to also improve the overall feasibility and effectiveness of the algorithm.     

Evidence-Based Pain Management and Palliative Care in Issue One for 2010 of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and also has been updated monthly online since January 2010. Issue 1 for 2010 contains 4125 complete reviews, 1924 protocols for reviews in production, and 11,887 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 608,000 randomized controlled trials, and 12,700 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7700 citations. This edition of the Library contains 98 new reviews, of which 7 that have potential relevance for practitioners in pain and palliative medicine are described.     

The Cancer Pain Practice Index: A Measure of Evidence-Based Practice Adherence for Cancer Pain Management in Older Adults in Hospice Care

Various clinical practice guidelines addressing pain assessment and management have been available for several years that pertain, at least to some extent, to older patients with cancer. Nonetheless, systematic evaluations or methodologically sound studies of adherence to pain management practice guidelines within Medicare-certified hospice programs are lacking. As part of a larger translating-research-into-practice pain improvement study involving older patients with cancer in hospice programs, we recognized the need to create a valid and reliable tool that can facilitate critical evaluation of hospice medical records for nurse and physician adherence to pain management guidelines to create a consolidated score for comparative and quality improvement purposes. We report the process used to create this tool, named the Cancer Pain Practice Index, and a guide to its use.     

Evidence-Based Pain Management and Palliative Care in Issue Three for 2009 of The Cochrane Library

ABSTRACT.?

The Cochrane Library of Systematic Reviews is published quarterly. Issue 3 2009 contains 3916 complete reviews, 1905 protocols for reviews in production, and 10,894 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 587,000 randomized controlled trials, and 11,800 cited papers in the Cochrane methodology register. The health technology assessment database contains 7947 citations. This edition of the Library contains 90 new reviews, of which 11 have potential relevance for practitioners in pain and palliative medicine.     

Evidence-Based Pain Management and Palliative Care in Issue One for 2007 of The Cochrane Library

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 3009 complete reviews, 1668 protocols of reviews and 5931 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 489,167 randomized controlled trials, 22 methodology reviews and 9048 cited papers in the Cochrane methodology register. The health technology assessment database contains 6358 citations. This edition of the Library contains 104 new reviews of which 6 have potential relevance for practitioners in pain and palliative medicine.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Evidence-Based Pain Management and Palliative Care in Issue Two for 2006 of The Cochrane Library

The Cochrane Library of Systematic Reviews is published quarterly. It now contains 2674 complete reviews, 1686 protocols for reviews in production and 6019 one page summaries of systematic reviews published in the general medical literature. In addition there are citations of 473,442 randomized controlled trials, 22 methodology reviews and 8255 cited papers in the Cochrane methodology register. The health technology assessment database contains 5648 citations. This edition of the Library contains 66 new reviews of which 4 have potential relevance for practitioners in pain and palliative medicine.     

Evidence-Based Pain Management and Palliative Care in the April Issue 2010 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published monthly online and in a DVD format four times a year. The April 2010 issue contains 6049 complete reviews, 1924 protocols for reviews in production, and 11887 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of over 608,000 randomized controlled trials, and 12,700 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7700 citations. This edition of the Library contains 91 new reviews, of which 9 have potential relevance for practitioners in pain and palliative medicine.     

Pain Management Practice and Guidelines in Jordanian Pediatric Intensive Care Units

Limited knowledge exists of current pain management practices and supporting guidelines in Jordanian pediatric intensive care units. To determine the current pain management practices and the availability and content of practice guidelines in Jordanian pediatric intensive care units, we conducted a cross-sectional and multisite survey of four pediatric intensive care units in Jordan. A questionnaire was developed and orally administered over the phone or in person to head nurses or their nominees to capture pain management practices and the existence and content of guidelines. All units had written pain management guidelines that included pain assessment, documentation, and management. All four units used one or more pain assessment tools. In three units, pain management was considered multidisciplinary and routinely discussed on unit rounds. In two units, continuous infusion of intravenous opioids was used as well as sedatives and neuromuscular blockers for most ventilated patients. In the two other units, continuous intravenous infusion of opioids was not used and only sedatives were administered for patients on mechanical ventilation. In two units, there were no specific guidelines on the use of nonopioid analgesics, patient-controlled anesthesia, or the management of postoperative pain. No unit used an opioid or sedative withdrawal assessment tool or had pain management guidelines on the use of topical anesthetic agents or sucrose. Pain management practices and guidelines varied across the four units, suggesting that there is an opportunity for improvement in pain management in pediatric intensive care units in Jordan.     

Primary Care for Mentally Ill Adults in Acute Residential Treatment Facilities

Psychiatric bed capacity has decreased nationally with an impact on the number and the types of patients admitted to acute in-patient units. Acute residential programs provide alternatives to hospitals for patients with problems that do not meet criteria for admission. However, these settings may not have resources to respond to the medical co-morbidities associated with severe mental illness. To understand the medical needs of patients in these settings, this research examined data from a nurse-managed primary care outreach service. Prevalent problems included acute issues and chronic disorders associated with severe mental illness. In multivariate analyses, demographic and substance related factors contributed to all chronic illness. However, age was the over-riding predictor of cardio-metabolic disorders. Drug abuse consistently predicted HIV/AIDS and HCV risk. Findings demonstrate that patients diverted to alternative forms of acute psychiatric care are no less in need of medical services than those admitted to hospitals. This underscores the importance of primary care that is provided at the site of acute residential treatment and integrated with overall care.     

癌症疼痛的评估及护理对策

癌症患者自觉症状中 ,癌痛发生率为最高。世界上约有 35 0万人在癌症疼痛的折磨中艰难度日 ,严重影响患者的治疗和生存质量。对癌症疼痛的评估及护理显得尤为主要。1　疼痛的评估评估疼痛的最佳方法是对疼痛本质的相信 ,使用可靠有效的工具并了解一些有关疼痛的问题 ,可以更好地理解疼痛的本质。[1]1.1　影响正确评估的因素[2 ]1.1.1　患者的年龄、性别、性格及文化背景 :一般来说 ,年长者较年幼者耐受疼痛 ,性格内向者对疼痛的主诉较少 ,同等程度的疼痛在性格外向者反应会强烈 ,主诉更多。民族、家庭、过去的经历对疼痛的评估均会产生影响…     

A Practical Guide for Implementing Evidence-Based Assessment in a Psychiatric Residential Treatment Facility: Translating Theory Into Practice

This article provides specific and practical guidelines for how to set up and implement an assessment protocol in a psychiatric residential treatment facility (PRTF) setting for the purposes of informing administrators and therapists of their residents' current and changing mental health status throughout the course of treatment. The assessment protocol we propose and recommend is (a) based on empirically supported research, (b) relatively inexpensive, (c) easy to administer, and (d) provides easily interpretable information to therapists. This protocol was also well-implemented at a child and adolescent PRTF located in the southern region of the United States (N = 254) and was well-received by staff therapists (N = 6). The current article may be used as a “How-To” guide for implementing an evidence-based assessment protocol in PRTFs to translate theory into practice.