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

Co-Investigators:
Institution:
Alberta Children's Hospital, Calgary
Presentations & Publications:
Presentations:
  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. 
Publications:

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.