![Best Audit Topic [logo]](/images/misc/bat.gif)
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
Choose and Audit to view
1st December 2007
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st December 2007 | All children attending the ED with a fracture injury, aged between 5 and 15. | Management of patient according to the criteria. | Pain score assessed at triage | 100 % | 77 % |
| Analgesia appropriate to pain score | 100 % | 53 % | |||
| Analgesia given within 20 minutes of triage time if indicated | 100 % | 76 % | |||
| Pain score reassessed if raised | 100 % | 13 % | |||
| Documentation of adequate support and splinting on discharge/admission | 100 % | - |
Comments
Some improvements noted, in particular with pain score reassessment and receiving appropriate analgesia. Unfortunately a significant decline noted in patients receiving analgesia within 20 minutes of arrival, from 48% to 13%.
Audit Bottom Line
Some improvement across the region, but still siginicant scope for improvement. Particular attention needs to be paid to ensuring patients receive timely analgesia on arrival.