Devanandhini Krisnan1, Sindhu Viswanathan1, Kavita M. Bhojwani1
1) Malaysia
The national Pain Free Hospital initiative began with the vision of holistic pain alleviation 1 . As part of the pilot team , Hospital Raja Permaisuri Bainun, Ipoh , began conducting dedicated Pain Free Hospital Rounds with a multidisciplinary team on a biweekly session since August 2016 in major departments on a rota basis. Pain induces a negative experience with detrimental neuropsychiatric effects to the paediatric population, yet insufficient efforts were made to address this issue 2,3,4,5. We report our paediatric experience since commencing these rounds . A major barrier in paediatric pain management has been the pain scoring which widely differs between different age groups , further compounded by those with disabilities. Pain Free Rounds has facilitated the Paediatric Intensive Care Unit and the Paediatric General wards to make possible the availability of numerous scoring systems and their usage in our daily practice. We also adopted framing Pain Scoring charts and the WHO Stepwise ladder at corners of the ward for quick look-ups to potentiate easier, more uniform pain management . Feedback from the auxiliary team members with regards to non-pharmacotherapeutic methods of pain management resulted in usage of screens as distractors, and hot/ cold packs which aided in reducing short acting analgesics for common peri-procedural pain . We also began implementing the use of EMLA for planned venepunctures in Paediatric ICU/ HDU setting. By virtue of following non-paediatric departmental rounds , we increased our pharmacotherapeutic arsenal with the introduction of Intravenous Ketorolac into our management . Pain Free Hospital Rounds has succeeded in raising awareness of pain amongst paediatric staff , more uniform documentation and management of pain and improving the methods of addressing pain amongst our patients , in keeping with national objectives . This incorporation of Pain management into clinical practice can and should be replicated throughout the country. 1. Smietańska I, Adrian E. Does the Pain-free hospital certification improve the management of pain following hernioplasty? Anestezjol Intens Ter. 2010 Oct-Dec;42(4):190-3 2.Anand KJ, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior? Biol Neonate.2000;77 (2):69– 82 3.Holsti L, Grunau RE, Oberlander TF, Whitfield MF. Prior pain induces heightened motor responses during clustered care in preterm infants in the NICU. Early Hum Dev.2005;81 (3):293– 302 4.Taddio A, Shah V, Gilbert-MacLeod C, Katz J. Conditioning and hyperalgesia in newborns exposed to repeated heel lances. JAMA.2002;288 (7):857– 861 5. Valeri BO, Holsti L. Neonatal pain and developmental outcomes in children born preterm: a systematic review. Clin J Pain. 2015 Apr;31(4):355-62
