Improving pain management for pediatric patients undergoing nonurgent painful procedures

Purpose. The development of a topical analgesia protocol to improve pain management for pediatric patients undergoing nonurgent painful procedures is described. Summary. Leadership from the departments of pediatrics, neonatology, obstetrics and gynecology, nursing, pharmacy, child life, and phlebotomy were chosen to develop and implement a new protocol for topical analgesia use for nonurgent painful procedures in pediatric patients. A review of the published literature on pain management in neonates, infants, children, and adolescents led to the replacement of lidocaine 2.5%-prilocaine 2.5% with liposomal lidocaine 4% topical cream on the formulary. In addition to topical analgesia, psychological and physical methods that enable children to cope successfully with anxiety-provoking and painful experiences were included as part of the education portion of implementation. Child life staff educated other staff, patients, and their parents on pain management techniques, including deep breathing, imagery, and the use of distraction tools. The protocol was transcribed onto preprinted prescriber order forms, which were made available to all pediatric inpatient units, the pediatric emergency department, and the pediatric ambulatory care clinic. A separate form was developed for neonatology. Data from before and after protocol implementation were collected and assessed. Only pediatric patients admitted to inpatient units or seen in ambulatory care clinics were included in the evaluation. The percentage of patients undergoing nonurgent painful procedures treated with topical analgesia or dorsal penile block for circumcisions rose from 2% (preimplementation of protocol) to 92% (postimplementation) (p < 0.0001, chi-square). Conclusion. A multidisciplinary approach to protocol development and implementation significantly increased compliance to a topical analgesia protocol for pediatric patients undergoing nonurgent painful procedures in a community medical center.