Predicting Who Receives Nonpharmacologic Pain Interventions in the Pediatric Intensive Care Unit.

AIMS: The majority of patients in the pediatric intensive care unit (PICU) experience pain daily, while nonpharmacologic interventions are indicated for pain management in children, there is limited information on which nonpharmacologic interventions are provided in the PICU and which patients receive those interventions. The aim of this descriptive correlational secondary data analysis was to determine what nonpharmacologic interventions were recorded in the electronic health record of PICU patients and patterns in use by patient demographics. SETTING/SUBJECTS: All patients hospitalized in 15 participating PICUs are located within 12 unique children's hospitals across the United States were eligible for participation. METHODS: Nonpharmacologic interventions used in the PICU were identified and differences between patients who did and did not receive those interventions were examined using Fisher's exact test. A generalized linear mixed effects model was constructed to determine patient characteristics that predict nonpharmacologic pain intervention application. RESULTS: Of 220 enrolled patients, 97 (44%) had nonpharmacologic pain interventions recorded in their electronic health record. The most frequently recorded interventions included repositioning (65%), decreasing environmental stimuli (55%), caregiver presence (37%), distraction (23%), and music therapy (20%). Children who had moderate to severe pain were most likely to receive nonpharmacologic pain interventions. CONCLUSIONS: Nonpharmacologic pain management is applied inconsistently across PICUs and may be underdocumented or underutilized. Additional research is needed to determine when nurses use nonpharmacologic pain interventions, their rationale for applying these interventions across differing groups, and the effectiveness of these interventions in managing pain in critically ill children.

Pain in the Pediatric Intensive Care Unit: How and What Are We Doing?

BACKGROUND: Pain management in critically ill children is complex. Epidemiological research is needed to identify how often patients in pediatric intensive care units experience pain and the practices being used to lessen pain. OBJECTIVES: To describe pain assessment and intervention practices in pediatric intensive care units, determine the prevalence of pain and painful procedures, and identify characteristics of children with moderate to severe pain. METHODS: A 24-hour observational cohort study was conducted in 15 units. Nurses completed surveys regarding patients' communicative ability. Patients' records were reviewed for pain assessments, painful procedures, and pharmacologic and nonpharmacologic interventions. RESULTS: For the 220 patients in this study, pain was assessed a median (interquartile range) of 10 (7-13) times, usually with behavioral pain scales. Sixty-eight percent of patients received pharmacologic interventions and 44% received nonpharmacologic interventions. Fentanyl was the most common analgesic provided. Repositioning was the most common nonpharmacologic intervention. Forty-five percent of patients had pain and 24% had moderate to severe pain. Patients experienced a median (interquartile range) of 7 (2-15) painful procedures in 24 hours. More frequent pain assessments and pharmacologic interventions and the ability to communicate were associated with moderate to severe pain. No patient in the moderate to severe pain category received neuromuscular blockers. CONCLUSIONS: Critically ill children experience pain and multiple painful procedures daily. Assessment and intervention practices vary considerably. Research is needed to establish best practices for pain assessment in patients with limited communicative ability and to determine which pain management strategies improve patients' outcomes.