Knowledge of paediatric procedural pain management among junior staff in a tertiary hospital

Tan Hai Liang1, Farah Khalid1, Chong Lee Ai1

1) Malaysia

Background and aims :

Procedural pain in children in hospitals is often overlooked. As part of an on-going project aimed at improving pain management, we sought to understand current practices by junior staff who perform most of the invasive procedures.

Method :

All paediatric house-officers were invited during a lunch break and information regarding the survey was given. Participation was voluntary. The 19-item questionnaire assessed their pain management of the last procedure specifically and all procedures collectively performed that morning.

Results :

Twenty house-officers participated and four were not available. The median time from graduation from medical school was 13 months (11-28months). Half of them had 6 weeks and less of paediatric experience. Majority 17 (85.0%) reported to have acquired most knowledge on pain management from ‘on-the-job training’ rather than from medical school. Eighteen (90.0%) declared to know how to assess pain, however only two-thirds carried out a pain assessment during their last procedure that morning. Eleven (91.7%) participants perceived patients experienced procedural pain with 7 (63.6%) of them perceiving pain to be moderate. The 2 most common procedure was heel/finger prick (10) and venepuncture (9). Six participants did not use any pain control measures.

For procedures collectively performed (84 procedures), the 2 most common were venepuncture 44 (52.4%) and heel/finger prick 37 (44.0%). The 3 most common pain control measures used were swaddling (18 patients), distraction (14 patients), sucrose (16 patients). The most effective pain control measures perceived by participants were sucrose (100% participants), distraction (83.3%), and ethyl chloride spray (66.7%).

Only 2 participants were aware of the existence of hospital guidelines for pain management and only 1 knew of the WHO guidelines.

Conclusion :

Children undergoing procedures were perceived to experience pain despite pain control measures. Hence efforts to improve procedural pain management should include education of junior doctors.