Pre-hospital paediatric pain management in the London ambulance service

Aim In 2006 the London Ambulance Service (LAS) developed a laminated card to allow for better pain assessment for children. The card contained a faces-based scoring system used in hospitals.1 LAS paediatric pain assessment and management was reviewed in 2012 demonstrating improvement in assessment of pain as a result of the card. Administration of pain relief also improved, however further progress was needed in analgesia provision and immobilisation. Following the review, paediatric pain management and immobilisation was included in LAS clinical training sessions, and a paediatric immobilisation equipment review was conducted. This project aimed to determine whether these additional initiatives further improved paediatric pain management. Method A retrospective review was undertaken of 229 clinical records from October 2014 to January 2015 for patients aged 12 years and under whose primary complaint was a possible fracture or dislocation. Clinical records were compared with national clinical practice guidelines for paediatric pain management. Results Findings showed nearly all patients had a pain assessment recorded (n=223, 97%), an improvement sustained from 2012 (+34% since 2006). We found an increase in the percentage of children having their injury immobilised (+22% since 2012; sustained from 2006; n=90/216, 42%) and being given analgesia when required (+18% since 2012;+61% since 2006; n=170/209, 84%). Conclusion The systematic cyclical process of reviewing care, implementing change and re-measuring, whilst resource intensive, has demonstrated huge improvements in paediatric pain management over time. https://bmjopen.bmj.com/content/8/Suppl_1/A26.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/bmjopen-2018-EMS.6