Chia Hooi Tzing1, Kuan Geok Lan1, Sabariah Bt. Idris1
1) Malaysia
Pain as a 5th vital sign (P5VS) was implemented in Malaysian Ministry of Health hospitals in 2008 and the policy included children from one month old. The Malaysian Pain Free Hospital (PFH) Initiative began in 2011, and to date, seven hospitals have been PFH certified. However P5VS has yet to be implemented in the government health clinics.
Immnunisation has been shown to be the most common cause of iatrogenic pain inflicted in children, and if left unaddressed, can lead to pre-procedural anxiety in the future, needle phobia, healthcare avoidance behaviours including non adherence with vaccination schedules. Such childhood fears have been shown to be the cause of 25% of adults having needle phobia.
In the Malaysian healthcare system, the majority of childhood immunisations are mainly carried out in the government primary healthcare system, with a smaller proportion by the private healthcare institutions. In an average year, about 12,300 immunisations (2015) were conducted in the district of Rembau, Negeri Sembilan, without pain reducing strategies.
For this study, pain reducing strategies eg distraction technique with bubbles, singing, rattle were carried out at Klinik Kesihatan Rembau amongst infants and children undergoing immunisation. All well babies registered at the clinic (April to July 2016) for immunization were included in the study, however babies with known allergies were excluded. Pain was measured using the FLACC score in the intervention (30) as well as control group (30). The results indicated that there was an average pain score of 6.4 in the control group compared to 1.8 in the intervention group.
Pain reducing strategies are simple but effective steps. It creates positive experiences in children, and enhances trust in healthcare providers. Is it time for the P5VS policy to be extended into the primary healthcare system?
