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Pain management of childhood fractures
Clinical scenario
Children are likely to be frightened by the experience of attending the ED and being seen and treated by many strangers. If, in addition, their pain is not well managed it will leave them with the memory of a bad experience.
Audit question
Is pain in childhood fractures managed appropriately according to best practice guidelines?
Method
Retrospective audit
Sample: 50 consecutive Emergency Department patient records
Criteria
Inclusions: Include children documented as having moderate or severe pain (pain score 4 to 10)
Exclusions: Exclude multiple injuries
Audits
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1st April 2009
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st April 2009 | All children attending the ED with a fracture injury, aged between 5 and 15. | Management of the patient according to the criteria. | Pain score assessed at triage | 100 % | 61 % |
| Analgesia appropriate to pain score | 100 % | 16 % | |||
| Analgesia given within 20 minutes of triage time if indicated | 100 % | 87 % | |||
| Pain score reassessed if raised | 100 % | 26 % | |||
| Documentation of adequate support and splinting on discharge/admission | 100 % | - |
Comments
A poor set of results overall, with decine in scores across the board.Particualrly disappointing was reassessment of pain score and timleness of analgesia.
Audit Bottom Line
Significant scope for improvement across the board, with particular attention paid to timeliness of anagesia and pain scoring.