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Pharmacy World and Science

, Volume 20, Issue 2, pp 66–72 | Cite as

The effects of a hospital staff training program on the treatment practices of postoperative pain in children under 8 years.

  • Kati Sepponen
  • Riitta Ahonen
  • Hannu Kokki
Article

Abstract

The widespread use of day case surgery for minor operations in children places increased emphasis on home care, parental responsibility and attention to suitable analgesia. This study evaluated a training program for doctors and nurses on postoperative analgesia in children by following up parental perceptions of pain relief after discharge. The main objective of our study was to determine the effects of a training program on treatment practices in the hospital and on the home care instructions provided. The study was carried out in two phases. A questionnaire was sent to parents of children aged under 8 years who had undergone a minor otorhinolaryngological operation (tonsillectomy, adenoidectomy, irrigation of maxillary sinus, insertion of grommets, or paracentesis) at the Day Case Unit in Kuopio University Hospital. The parents of 115 children returned the questionnaire in the preintervention study and those of 112 children in the postintervention study (response rates: 79% and 86% respectively). The training program for personnel (intervention) was organized between the two studies. It started with a one‐hour lecture on postoperative pain and pain treatment in children, and the lecture was followed by two weeks of bedside teaching. The overall standard of pain treatment in the hospital was good. Most of the children had no pain or only mild pain on discharge (93% before the intervention and 90% after the intervention). The intervention had no effect on the likelihood of children receiving pain medication. Noticeable changes occurred in the selection of pain medicines and dosage forms, and in the increased number of home care instructions provided for parents. We conclude that the training program for both professional groups (doctors and nurses) can be beneficial in changing the treatment practice (especially the use of medicines and dosage forms). Such training programs also make it possible to emphasize the importance of proper instructions for home care and thus to improve the quality of information provided for parents.

Adenoidectomy Children Day case surgery Dosage forms Education, professional Home care Medication Pain, postoperative Personnel, hospital Tonsillectomy 

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References

  1. 1.
    McGrath PJ, McAlpine L. Psychologic perspectives on pediatric pain. J Pediatr 1993;122: S2–S8.PubMedGoogle Scholar
  2. 2.
    Schechter NL. The undertreatment of pain in children: an overview. Pediatr Clin North Am 1989;36: 781–94.Google Scholar
  3. 3.
    Gedaly-Duff V, Ziebarth D. Mother's management of adenoid-tonsillectomy pain in 4-to 8-year-olds: a preliminary study. Pain 1994;57: 293–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Maunuksela EL, Olkkola KT, Korpela R. Measurement of pain in children with self-reporting and behavioral assessment. Clin Pharmacol Ther 1987;42: 137–41.PubMedGoogle Scholar
  5. 5.
    McGrath PA. An assessment of children's pain: a review of behavioral, physiological and direct scaling techniques. Pain 1987;31: 147–76.CrossRefPubMedGoogle Scholar
  6. 6.
    Schechter NL, Bernstein BA, Beck A, Hart L, Scherzer L. Individual differences in children's response to pain: role of temperament and parental characteristics. Pediatrics 1991; 87: 171–7.PubMedGoogle Scholar
  7. 7.
    Bartley JR, Connew AM. Parental attitudes and postoperative problems related to paediatric day stay tonsillectomy. N Z Med J 1994;107: 451–2.PubMedGoogle Scholar
  8. 8.
    Schechter NL, Berde CB, Yaster M. Pain in infants, children, and adolescents: an overview. In: Schechter NL, Berde CB, Yaster M, eds. Pain in infants, children, and adolescents. Baltimore: Williams & Wilkins, 1993: 3–9.Google Scholar
  9. 9.
    Bellman MH, Paley CE. Pain control in children-parents underestimate children's pain. BMJ 1993;307: 1563.Google Scholar
  10. 10.
    Finley GA, McGrath PJ, Forward SP, McNeill G, Fitzgerald P. Parents' management of children's pain following ‘minor’ surgery. Pain 1996;64: 83–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Ray WA, Schaffner W, Federspiel CF. Persistence of improvement in antibiotic prescribing in office practice. JAMA 1985;253: 1774–6.PubMedGoogle Scholar
  12. 12.
    Maiman LA, Becker MH, Liptak GS, Nazarian LF, Rounds KA. Improving pediatricians' compliance-enhancing practices: a randomized trial. AJDC 1988;142: 773–9.PubMedGoogle Scholar
  13. 13.
    Davis DA, Thomson MA, Oxman AD, Haynes RB. Evidence for the effectiveness of CME: a review of 50 randomized controlled trials. JAMA 1992;268: 1111–7.PubMedGoogle Scholar
  14. 14.
    Medicalaudit in general practice. I: Effects on doctors' clinical behaviour for common childhood conditions. North of England Study of Standards and Performance in General Practice. BMJ 1992;304: 1480–4.Google Scholar
  15. 15.
    Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993;342: 1317–22.CrossRefPubMedGoogle Scholar
  16. 16.
    Kokki H, Hendolin H, Maunuksela E-L, Vainio J, Nuutinen L. Ibuprofen in the treatment of postoperative pain in small children. A randomized double-blind-placebo controlled parallel group study. Acta Anaesthesiol Scand 1994;38: 467–72.PubMedGoogle Scholar
  17. 17.
    Nikanne E, Kokki H, Tuovinen K. I.v. perioperative ketoprofen in small children during adenoidectomy. BJA 1997;78: 24–27.PubMedGoogle Scholar
  18. 18.
    Vaskilampi T, Kalpio O, Ahonen R, Hallia O. Finnish study on medicine use, health behaviour and perceptions of medicines and health care. In: Trakas DJ, Sanz E, eds. Childhood and medicine use in cross-cultural perspective: a European concerted action. Euro-report No. 16646. Luxembourg: Office for Official Publications of the European Union, 1995: 191–220.Google Scholar
  19. 19.
    Mäkelä P. Lapset lääkkeiden käyttäjinä-tutkimus lapsen toimenpiteen jälkeisen kivun kokemisesta ja lääkityksestä kotona (Children as the users of medicines-a research on children's experiences on postoperative pain and its treatment at home). Master's thesis (unpublished). University of Kuopio, Department of Social Pharmacy, 1995: 56.Google Scholar
  20. 20.
    Maiman LA, Becker MH, Katlic AW. Correlates of mothers' use of medications for their children. Soc Sci Med 1986;22: 41–51.CrossRefPubMedGoogle Scholar
  21. 21.
    Isaacman DJ, Purvis K, Gyuro J, Anderson Y, Smith D. Standardized instructions: do they improve communication of discharge information from the emergency department? Pediatrics 1992;89: 1204–8.PubMedGoogle Scholar
  22. 22.
    Russell IT, Grimshaw JM. The effectiveness of referral guidelines: a review of the methods and findings of published evaluations. In: Roland M, Coulter A, eds. Hospital referrals. Oxford: Oxford University Press, 1992: 179–211.Google Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • Kati Sepponen
    • 1
  • Riitta Ahonen
    • 2
  • Hannu Kokki
    • 3
  1. 1.Department of Social PharmacyUniversity of KuopioKuopioFinland
  2. 2.Department of Social PharmacyUniversity of KuopioKuopioFinland
  3. 3.Department of Anesthesiology and Intensive CareKuopio University HospitalKuopioFinland

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