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Pain program makes emergency visits less intimidating for children

Cumming School researchers help reduce anxiety and pain for young patients at Alberta Children’s Hospital
January 8, 2016
Dr. Antonia Stang, assistant professor in the Department of Paediatrics and Community Health Sciences, visits with five-year-old Micah, who has a fractured wrist. Micah is participating in a program to reduce pain in children in the emergency department at the Alberta Children's Hospital. Photos by Julia Klenin

Dr. Antonia Stang, assistant professor in the Department of Paediatrics and Community Health Sciences, visits with five-year-old Micah, who has a fractured wrist. Micah is participating in a program to reduce pain in children in the emergency department at the Alberta Children's Hospital. Photos by Julia Klenin 

Dr. Jennifer Thull-Freedman is the quality safety lead in the emergency department of the Alberta Children's Hospital. She is pictured here with mom Lindsay McKay and her daughter Micah; McKay says the program made the emergency department experience less intimidating for her daughter.

Dr. Jennifer Thull-Freedman is the quality safety lead in the emergency department of the Alberta Children's Hospital. She is pictured here with mom Lindsay McKay and her daughter Micah; McKay says the program made the emergency department experience less intimidating for her daughter.

To help emergency department staff to more accurately assess the level of pain, each patient is being given an individual, bookmark-sized pain scale to help them describe their pain.

To help emergency department staff to more accurately assess the level of pain, each patient is being given an individual, bookmark-sized pain scale to help them describe their pain. 

A new initiative is underway to reduce anxiety and pain for children visiting the emergency department at the Alberta Children’s Hospital.

Last fall, the Commitment to Comfort program was launched. It aims to improve a child’s comfort and reduce their pain as they receive care. The program was developed by Alberta Health Services and Cumming School of Medicine team of doctors, nurses and child life specialists.

The two lead emergency physicians are Dr. Jennifer Thull-Freedman and Dr. Antonia Stang, both members of the university’s Alberta Children’s Hospital Research Institute for Child and Maternal Health (ACHRI).

“Treating pain is one of our highest priorities. It’s also important to the patients and families we see in the emergency department,” says Thull-Freedman, a clinical associate professor in the Cumming School of Medicine’s Department of Paediatrics.

“No one wants to see their child in pain; it adds stress to an already stressful situation for the patient, families, and staff alike. This initiative works to educate our families about the options available to them, as well as provide pain-management options to every patient who walks through our doors.”

Young patients with injuries decline pain medication, fearing needles 

Work on the project began two years ago when the two paediatricians looked into what they could do to better manage pain. In talking to patients with painful injuries, they discovered that about 15 per cent of children said they would have taken pain medicine, but none was offered to them, while 18 per cent said they felt their pain was not being managed effectively.

“Some patients told us that when they were offered a pain medicine, they declined it as they thought it might come in a needle,” says Thull-Freedman.

“In other instances, parents weren’t sure if they should accept pain medication for their child before the doctor had a chance to check the injury,” adds Stang, an assistant professor in the Department of Paediatrics and Community Health Sciences.

Emergency department highlights pain management options

To promote the campaign, comfort menus on the types of pain-management options available now are clearly displayed within emergency. They range from needle-free pain medication to an ice pack, a warm blanket or a toy to play with such as a light wand or tablet computer. Patients are also being given an individual, bookmark-sized pain scale to help them describe their pain, to help emergency department staff to more accurately assess the level of each patient’s pain. 

Lindsay McKay has nothing but praise for the program. She and her five-year daughter old Micah Shaw came to the emergency department after Micah fractured her wrist during Christmas while skating. McKay found the toys useful in distracting her daughter while Micah was being treated and says, “it made the experience a lot less intimidating for my daughter."

In addition, doctors and nurses have received more education on how to support a child in pain. Comfort positions are promoted when a child needs a procedure, so he or she can sit up, snuggle a parent and feel in control, rather than having to lie flat.

Program expanding to other departments at Alberta Children's Hospital

According to Thull-Freedman, the program benefits staff as well. “We’ve made it easier for our staff to do something that’s really important to them,” she says. “We have so many things to prioritize, we may not always notice the child who is experiencing his or her pain quietly. By inviting families to partner with us, we’ve been able to reach more kids.”

Plans are now being made to expand the program into other departments at the Alberta Children’s Hospital as well as to more emergency departments across Calgary by late spring.