Research Award Details

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A prospective audit of pain management for pediatric orthopedic patients after discharge from hospital

Grant Recipient: Elaine Joughin, MD, FRCSC

Alberta Children's Hospital, Calgary
Presentations & Publications:
  1. Podium presentation at the Annual meeting of the Canadian Orthopedic Association in 2019
  2. E-poster presentation at the Annual meeting of the Canadian Orthopedic Association in 2020
  3. Poster presentation at the Alberta Children’s Hospital Quality Forum in 2018 and 2019. 

Findings will be published once the detailed data analysis is concluded.
Further Funding:
Additional Information:
Summary of the project:
A prospective audit of pain management in patients discharged home after orthopedic surgery (both inpatient and outpatient procedures) at the Alberta Children’s Hospital was conducted to determine whether current post-discharge pain control strategies are meeting the needs of patients/families during the immediate post-discharge period (first 48 hours) and to identify deficiencies in pain relief provided.
The parents/patients were surveyed on the first and second days post-discharge via phone or online to gain information on analgesia administered at home, pain evolution in terms of time/intensity during this period, discharge teaching provided to parents/caregivers and parental feedback on the current post-discharge pain management plan and suggestions for improvement. Medication diaries were provided to parents to record medications administered within the 48 hours post-discharge. Pain medications were prescribed according to the usual practice of the staff orthopedic surgeons. Children’s pain was assessed objectively using age appropriate pain scales.
Progress of study:
The audit was successfully concluded and a total of 357 respondents with complete data were included in the final data analysis. Currently data is being further analyzed for more details.
Study findings so far:
  • Non-opioid medications provided satisfactory pain relief for most procedures while opioid supplementation were required for only a limited number of procedures.
  • Pain scores were higher in patients that were prescribed opioids and also in those who took the prescribed opioids.
  • Parental/patient satisfaction was good regardless of whether opioids were prescribed or not.
  • Patients that receive opioids will not take them if their pain is controlled with non-opioid medication.
  • If a prescription for opioids is required, fewer than 5 doses should be given in most cases.
  • Provision of opioid prescriptions is still important to provide adequate analgesia after some orthopaedic procedures.
Future plans and related projects:
  • Based on the preliminary findings of this audit, a quality improvement project was conducted in collaboration with the nursing staff to improve staff education & parent discharge education. We received funding support for this project from the Chief Medical Officer (CMO)/Calgary Zone Medical Affairs (MA) Quality Improvement Initiative. Working with a group of key stakeholders which included nursing administration and unit staff, orthopedic surgeons and a dedicated group of parent volunteers, a set of 22 recommendations that are appropriate, realistic and sustainable for Alberta Children’s Hospital to invest the time and effort into implementing was established.
  • The next initiatives for this research will be determined following the detailed data analysis.