Management Principles in an Inpatient Pediatric Unit - Assignment Example

Management in an Inpatient Pediatric Unit al Affiliation: Introduction Preventing and managing pain is very crucial in healthsector. Individuals have recognized that pain, specifically when it is prolonged; it requires a broad, incorporated and versatile modeling in heath care. This Report illustrates the existing thoughts concerning management of pain incorporating the very essential factors that have to be considered in order to devise a valuable model for people who experience pain. Several challenges occur in this field of managing pain when working with patients with complicated pain experiences. Laws, rules and regulations together with health and social policy influence how to manage pain in patients. This report features what is constituted in a healthcare model along with succinct description as well as discussed findings from the literature review (Wood, 2011). Pediatric patients and children who go through painful procedures frequently do so without the use of analgesics or psychological coping methods. Topical analgesics and non-pharmacological measures safely decrease procedure-related pain in children but are usually underutilized. Failure to reduce pain at initial procedures results to a stronger pain response when a subsequent painful procedure is administered without adequate analgesia. Implementing evidence-based multidisciplinary protocols that mitigate discomfort from procedures done to pediatric patients has been shown to be safe and effective. This protocol provides effective education, gives alternative therapies and develops policies through training (Aggarwal, 2010). This can only be achieved through early intervention and prevention, creating community awareness along with a better access to pain management services all of which are natured by a theoretical basis, EBP and defined standards. This model is developed to make sure that health professionals and nurses head in the same direction with preset goals and objectives. Strategies aimed at preventing and managing acute and chronic pain in children should be outlined early in advance. This should be accompanied with valid and comprehensive screening and assessment tools and processes (Nicholas et al. 2011). Patients should actively be involved in treatments by seeking clarifications as to why certain treatments are necessary so that the right treatment is conferred to the right patient for the right reasons (Bedard et al. 2006). Health care experts and nurses should be well educated and should strictly adhere to the preset guidelines and protocols along with applying evidence acquired from researches (Berger et al. 2010) Patients with chronic and acute pain can be transferred to care mode while the many of patients experiencing chronic pain are managed in the primary care sector. Some of them require varying degrees of intervention through inpatient, outpatient or outreach activities which are found in public hospital systems, general practitioners’ admission, related health and other community based services (Bishop and Wing 2006; Matthias et al. 2010). A better criterion for attending specialist pain should be improved and if the case worsens, patients should be discharged to community and primary care services. Use of good communication facilities in the hospital and the necessary technology is highly recommended. For the case of children, there should be improvements in pediatric surgical pain management like enhanced partnership with the pain team, using other alternative options in reducing pain like non-pharmacological methods, including child life services early enough along with practice in pain reducing protocols by nurses. Increasing mobility and improving diet can also be a good motive to mitigate discomfort (Wood, 2011). Development and dissemination of family and patient educative materials like pamphlets which focus on pain management can as well improve the understanding of the case and [parents can freely make decisions on measures to reduce pain in children even without the pain team intervening. Feasibility of implementation Pain management team consists of professional, therapists of physiology and exercises, psychologists, along with physicians with a particular interest in occupational medicine. The cost of implementing this model takes into account the compensations to such professionals but a decrease in costs of health care is experienced. Adapting to the current technology in pediatric units is also an expense together with resources utilized in educating the nurses on using treatment measures that are based on research. The duration of working in implementing the measures reduces from rapid attention to children while maintaining their satisfaction. Parents will save from minimal expenses in purchasing drugs and other resources in treatments. Lin et al. (2011) examined cost effectiveness of protocols for EBP and found that there is evidence supporting the cost-effectiveness of endorsing the guidelines. Objectives and goals A team was organized to develop and implement a strategy to improve pediatric pain management. Leaders from the departments affiliated to the pediatric department developed a new protocol for topical analgesia to be used in non-urgent painful procedures (Aggarwal, 2010). The team’s primary goal was to advance the quality of pediatric pain management by; Boosting the use of topical analgesics for pediatric patients undergoing non-urgent painful procedures Promoting the use of topical analgesics and dorsal penile block during circumcisions. Educate patients and health care professionals on non-pharmacologic methods of pain management like behavioral distraction, kinesthetic methods, diversionary therapies, meditation and imagery. Expected outcomes There are a variety of outcomes observed from the literature reviewed. The use of evidence based guidelines results in improved patient outcomes. The delivery of intense and costly programs to people without high level need is likely to lead to inappropriate use of resources and over-servicing of those for whom less intensive programs would be of equal benefit. The nature of incorporated curative processes like physical and behavioral will affect the patient experience, commitment and outcomes. There is need for more systematic coding of pain in order to determine patient and system outcomes related to care processes and programs. Stetler model of evidence-based practice Relevance for Public Health and Pain Management The Stetler model of evidence-based practice helps public health officers and practitioners use evidence in daily to inform program planning and implementation. It can be a useful model that uses research evidence for nurses and practitioners to manage pain in little children. Combining research and the little available supplemental evidence helps in decision making and provides the first step for actions related to research that result in evidence-informed practice (Bernadette, 2011). In this model, the internal characteristics of the practitioner along with the external environmental factors influence the use of knowledge. It is based on the following assumptions (Stetler, 2001); The Inpatient Pediatric Unit may or may not be involved in practitioner’s use of research or other evidence. Using this model may be instrumental, conceptual or symbolic. Other non-research-related information sources are likely to be combined with research findings to aid in decision making. Internal or external factors can influence how an individual or a group can use evidence. Research information and evaluation provide probabilistic information. Lack of knowledge and skills pertaining to research use and evidence-informed practice can inhibit appropriate and effective use. This model entail five phases (Stetler, 2001): Phase I: Preparation—Purpose, Context and Sources of Research Evidence Here the purpose of consulting the evidence is identified. In this case it is managing pain in pediatric unit for children along with identifying the relevant resources. Phase II: Validation or Credibility of Findings Each source of evidence is assessed for its level of overall credibility, applicability and operational details assuming that a methodologically weak study may as well provide useful information in light of additional evidence (Williams, 2011). Phase III: Comparative Evaluation/Decision Making Summarized findings are logically organized and displayed from across all validated sources in terms of their similarities and differences and the feasibility of application in practice determined. Phase IV: Translation/Application Generalizations that logically take research findings and form action terms are taken. The how-tos of implementation are articulated from the synthesized findings. At this stage, Type of research use is identified Method of use is identified The level of use is identified. Translation of whether the use goes beyond actual findings/evidence is made The need for appropriate, reasoned variation is considered in certain cases Formal dissemination and change strategies are planned Phase V: Evaluation Clarification of the expected outcomes relative to purpose of seeking evidence is done. Formal and informal evaluations of applying findings in practice are differentiated. Cost-benefit of various evaluation efforts are considered. Research Utilization as a process is used (Stetler, 2001) to enhance the credibility of evaluation data. The two types of evaluation data: formative and outcome are used. PART 2 Proposed solution There is a need to develop analgesic guidelines. The departments of pediatrics, neonatology, OB/GYN, nursing, and pharmacy should establish guidelines for the use of topical analgesia in managing pediatric pain during surgical procedures (Harkins, 2011). Based on the literature reviewed, the longer onset of aneshtesizing action of lidocaine cream was identified as contributing factors for non-compliance to the previous topical analgesia protocol, which takes more than an hour (Mooney et al, 2006). It also causes less skin blanching and vasoconstriction and can consequently increase rates of successful cannulation on the first attempt. Prilocaine metabolite oxidizes hemoglobin to methemoglobin, which can cause methemoglobinemia. Application of liposomal lidocaine cream is recommended 20 minutes before a nonurgent painful procedure. During circumcisions, lidocaine cream or dorsal penile nerve block is highly recommended. The pharmacy department and inpatient pediatric units should be supplied with ambulatory care clinic and recommended analgesics in automated dispensing devices in that way improving accessibility of drugs and decreasing the time to drug administration. Feasibility of implementation Publication and direct mailing of the above guidelines should be conducted to all departments of pediatrics. The nursing staff, pharmacists and child life specialists should get in-service education about the indications and contraindications for topical analgesia. Parents, guardians and patients have the right to refuse pain management at any time (Kaushal et al, 2001). Evidence-based multidisciplinary protocol utilizing topical analgesics should be implemented in pediatric units to safely reduce pain associated with non-urgent painful procedures (Hughes Rockville, 2008). Psychological and physical methods that enable a child to deal with painful experiences, including behavioral distraction, kinesthetic methods like patting the child, should be in cooperated in education program. Resources Pediatricians, neonatologists and other prescribers would be essential in pain management strategies, with the pediatric house staff and nursing staff enforcing these regimens. OB/GYN staff would be responsible for encouraging the use of pain management for circumcisions. Pharmacy staff would be responsible for developing and implementing preprinted prescriber order forms to educate physicians and nurses about the topical analgesics along with readily availing forms. Child life staff would educate health care professionals and patients on non-pharmacologic pain management methods. It is within the duty of Phlebotomy staff to ensure administration of analgesic before surgical operations. Possible outcomes The fraction of patients that underwent non-urgent painful procedures treated using topical analgesia or dorsal penile block for circumcisions grew with time. Some children and parents opposed pain-monitoring techniques. Compliance to the protocol was minimal during the initial stages of implementation due to the issue of timing where a physician is unable to wait for analgesia to be administered (Needleman et al, 2011). However, with time, these noncompliant physicians respected opinion from leaders within their department through education about the value of the protocol. The nursing staff also coordinates analgesia with arrival of the physician. On the course of protocol evaluation, two severe events were reported with the first involving an infant from the pediatric outpatient clinic who licked the lidocaine cream off the site of application, with no unpleasant effects noted. Another child developed swelling of the penis glans shortly after application of liposomal lidocaine cream against expectations but when the cream was removed, the swelling suddenly resolved. Conclusion Various strategies have always been established to improve pain management for pediatric patients and children who undergo elective painful procedures that focus on avoiding unnecessary pain. These include strategies like techniques of reducing pain such as preparing the child and parent through inviting the parent or guardian to be available when surgical procedure is being performed as well as containing a peaceful atmosphere. These interventions have long lasting benefits since they are often synergistic with analgesics and anesthesia. Specialists in Child life should provide necessary assistance to parents of the children and educate the nursing staff about pediatric pain when treating patients who undergo potentially painful elective procedures (Harkins, 2011) References Agency for Clinical Innovation (2010). Submission to Productivity Commission Inquiry into Disability Care and Support. Available at http://www.pc.gov.au/__data/assets/pdf_file/0009/99819/sub0093.pdf . Here the author is describing through a report the system that supports better child care and development needs together with the work force by the parents in achieving a comfort environment for children experiencing pain. Aggarwal V.R., M.Tickle, H.Javidi and S.Peters 2010.Reviewing the evidence: can cognitive behavioral therapy improve outcomes for patients with chronic orofacial pain? Journal of Orofacial Pain.24(2):163-71 The authors describe pain, particularly persistent one, as a multidimensional incident that requires a broad, incorporated and multifaceted model of care. They project that models of care should reflect a “stepped care” advance that facilitates the recognition and management of those at risk, matching the treatment to the needs of the individual while considering a wide range of intervention levels. Arora, S., S. Kalishman, D. Dion, D. Som, K. Thornton, A. Bankhurst, J. Boyle, M. Harkins, K. Moseley, G. Murata, M. Komaramy, J. Katzman, K. Colleran, P. Deming, and S. Yutzy. 2011. Partnering Urban Academic Medical Centers and Rural Primary Care Clinicians to Provide Complex Chronic Disease Care. Health Affairs 30 (6):1176-1184. Many Americans expect to be covered under the Affordable Care Act but have high levels of unmet need because of various chronic illnesses and live in underserved areas. The authors talk about ECHO project in Mexico that uses the state-of-the-art telehealth technology along with case-based learning to enable specialists to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with chronic pain and hepatitis C. Bédard, D., M.A. Purden, N. Sauvé-Larose, C. Certosini, and C. Schein. 2006. The Pain Experience of Post Surgical Patients Following the Implementation of an Evidence-Based Approach. Pain Management Nursing 7 (3):80-92. Here the authors describe how effective pain management has promoted earlier mobilization, reduced hospital stays, adequate rest, postoperative complications as well as costs. Patients answer questions about the surgical pain, their satisfaction, and beliefs with regard to pain management that produced results suggesting that managing pain through a variety of evidence-based strategies which are targeted at level of the institution, the clinicians, and the patient himself may lead to desired outcomes for them. Kaushal, R., Bates, D. W., Landrigan, C., McKenna, K. J., Clapp, M. D., Federico, F., & Goldmann, D. A. (2001). Medication errors and adverse drug events in pediatric inpatients. Jama, 285(16), 2114-2120. The authors assessed the rates of medication errors, adverse drug events (ADEs) as well as potential ADEs; in an effort to compare pediatric rates with previously reported adult rates, to analyze the major types of these errors and to evaluate the potential impact of evidence-based prevention strategies. Medication errors were found to be common in pediatric inpatient settings and hence further efforts need to be undertaken to reduce these errors. Hughes Rockville, 2008.Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Show details Agency for Healthcare Research and Quality (US), 2008 Apr. Throughout the pages of this handbook, Hughes Rockville has discussed and reviewed a wide range of issues and literature that regard the safety of a patient and quality health care he/she is subjected to. This book provides some insight into the multiple factors that determine the quality and safety of health care as well as patient, nurse, and systems outcomes. It examines the state of the science behind practicing and developing evidence based quality and safety concepts. To achieve goals in patient safety and quality which are a core duty for nurses and improve health care throughout the nation, they must assume their leadership role. Roth, M.A., D.A. Tripp, M. Harrison, Nicholas J, M. Sullivan, and P. Carson. 2007. Demographic and Psychosocial Predictors of Acute Perioperative Pain for Total Knee Arthroplasty. Pain Research & Management 12 (3):184-195. Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045. Mooney, D. P., Rothstein, D. H., & Forbes, P. W. (2006). Variation in the management of pediatric splenic injuries in the United States. Journal of Trauma and Acute Care Surgery, 61(2), 330-333. Browne, A.L.,R. Andrews, S.A. Schug, and F. Wood. 2011. Persistent Pain Outcomes and Patient Satisfaction with Pain Management After Burn Injury. Clinical Journal of Pain 27(2):136-45. Bernadette Mazurek Melnyk, Ellen Fineout-Overholt, Lippincott Williams & Wilkins. (2011). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice Stetler, C. (2001). Updating the Stetler model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49, 272-279. DOI: 10.1067/mno.2001.120517 Read More