Kathryn Russell1, Debbie Murray1
1) New Zealand
Major paediatric burn patients experience many procedures. This serial case review aims to gain an understanding of the pattern of procedures for major paediatric burn patients, and review mitigation measures for pain to improve future patient outcomes.
Seven consecutive NZ paediatric patients who had been treated at the National Burn Centre with above 30% total body surface area burns were reviewed. The number and nature of medical procedures was recorded from medical notes. In addition pain score, reports of emotional distress or pain, and documented pain management (pharmaceutical and non-pharmaceutical) were extracted from the records.
All patients had a large number of procedures, averaging five a day in the first two weeks. In total 1416 procedures were recorded for the seven children. Procedures only reduced in the week before discharge or transfer. Often pain medication was tailored for background pain. Dressing changes were more likely to have dedicated pain medication and hospital play specialist support than other procedures. Pain scores were recorded for <1% of procedures and distress was recorded for 6% of procedures. Pain medication was used for 42% of procedures and non-medication pain management was only recorded for 3% of procedures.
These children have on-going frequent procedures with little evidence of coordination or pain evaluation. More consideration needs to be taken in preparing an overall procedure plan to improve the patient experience and long term outcomes. A procedural plan allows concurrence of procedures to facilitate reduced procedure days or times, and minimises overlay of sedation. Procedure clustering during theatre visits greatly reduces the number of procedures a child experiences.
Declarations: None
