Current Content
Volume 49 - Number 1
January/February 2023

Implementation of a Non-Sedated Procedural Pain Management Practice Guideline and Order Set

Lisa M. Ring, Md Sohel Rana, and Nina Deutsch

Background: Pediatric patients are subject to numerous painful procedures during their hospitalization. These procedures can cause pain and anxiety that may be under-estimated and under-treated. Research shows that patients undergoing painful procedures receive suboptimal relief for pain and anxiety (Bice et al., 2014).

Methods: A non-experimental design used retrospective chart reviews for comparison of patient care before and after implementation of a new nursing practice guideline (NPG) and order set/power plan (PP) on three inpatient units. An assessment of nursing and provider knowledge of pharmacologic and non- pharmacologic analgesia and the non-sedated procedural pain NPG/PP was completed. A nursing satisfaction survey assessed use and feasibility of the NPG.

Findings: After educational implementation, nurses and providers significantly improved their knowledge of peak onset of morphine and oxycodone (p < 0.001). Nurses demonstrated significant improvement in reports of NPG utilization and knowledge of pharmacological and non-pharmacological resources (p < 0.001). Providers gained familiarity with the NPG/PP (p < 0.001). There was no evidence in the electronic health record (EHR) documentation to confirm the transfer of knowledge and compliance related to the NPG/PP.

Discussion: This multidisciplinary quality improvement project improved nursing and provider knowledge of non-sedated pediatric procedural pain pharmacologic and non-pharmacologic resources in our organization. EHR documentation limitations may have contributed to the evaluation of resource application.

Application to Practice: By improving knowledge of resources, we hope to increase compliance, improve pain control, and continue to evaluate their use during these short procedures. Redesign of the EHR is essential to help facilitate and evaluate NPG/PP compliance.