187: Changing Pain Management Practices in a Pediatric ED: Teamwork Works!
Bibliographic record
Abstract
Pain control in pediatric emergency department (PEDs) is often suboptimal, but quality improvement (QI) initiatives to change healthcare providers' practices are often fraught with difficulties. To develop a multidisciplinary team approach to the management of pain in a PED, in order to improve procedural pain control. In spring 2013, an interdisciplinary group of ED staff (nurses, physicians, administrative) from a tertiary care pediatric university hospital was created to explore pharmacological and non-pharmacological opportunities to improve pain relief in ED patients. Frequent, brief meetings – in collaboration with hospital pharmacists, pain management researchers, and the hospital's pain team - allowed for the identification of barriers to pain management, areas needing improvement and easy, low-cost solutions that would be acceptable with minimal staff resistance. To assist these practice changes, one nursing team was identified as test group, facilitating feedback about chosen methods and enhancing both the pain team's and the staff's capacity to adapt to barriers to implementation. During the trial period, structured written feedback (quantitative and qualitative) was provided for every intervention to guide choices. Training regarding new approaches was then provided to all PED physicians and nurses. Venipuncture was chosen as the first QI initiative. The table presents achieved practice changes to reduce procedural pain during venipuncture (six months after pain team's creation). The topical anesthetic was chosen based on literature review but also on written comments from nursing staff regarding pain control efficacy, loss of vascular anatomy and ease of use. Using an interdisciplinary approach to pain management methods allowed for the development of creative, realistic, low-cost and achievable goals in a short time span. Also, implementing the project progressively allowed for constant, immediate feedback and adjustments. Such working models could be used to create various clinical guidelines and to facilitate actual practice changes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.009 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".