1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com Reliable Pain Assessment Tools in a Rural Hospital for a Pediatric Population Rachel Shaw, Tamara Thurman, Erin Burdeshaw SUMMARY CONCLUSION IMPLEMENTATION/EVALUATIONPPAARE COURSE OF ACTION CASE STUDY FOCUS QUESTION The purpose and goal of this query is to: determine which pain assessment tool is more reliable when caring for pediatric patients in a rural hospital. The focused question is to: determine what the highest level of evidence is that we have available in understanding whether the FACE or FLACC pain assessment tool is the best method to quantify pain of a pediatric population in a rural hospital. Based upon the evidence, we chose to incorporate the FLACC assessment tool. Visual aids were placed above every bed so that patients could refer to the assessment tool and ask questions should any arise. Particular pain intervention protocols were discussed with the family. Many parents who assisted in reporting pain of their children were educated as to how the FLACC tool assisted the clinical staff. We measured outcomes in two ways: We surveyed the clinical staff at the three- month post-implementation mark as well as the 9-month post-implementation mark. some staff were unprepared to document appropriately up to 6 months post implementation. Questionnaires were sent to the parents of each pediatric patient post-discharge For questions or comments please contact Rachel Shaw rshaw@aum.edurshaw@aum.edu Erin Burdeshaw eoconnor@aum.edueoconnor@aum.edu Tamara Thurman tthurma1@aum.edutthurma1@aum.edu. TARGETED RESOURCES Our focus was on the validity and reliability of the FLACC and FACE pain assessment tools in a pediatric patient population in a rural hospital setting Both the FLACC and FACE pain assessment tools were valid and reliable tools for use in a pediatric population in a rural hospital setting. The FLACC assessment tool offers a greater population application. There are many pain assessment tools which are useful in the clinical environment In certain populations, especially pediatrics, ascertaining an appropriate response may be more difficult. Our group researched the best pain assessment tool to use for a pediatric population in a rural hospital setting. The steps in the evidence-based process (EBP) will be used to guide us in finding the best evidence to address a question introduced in the case study. Howlett, B., Rogo, E.J., and Shelton, T.G. (2014) Evidence-based Practice for Health Professionals: An Interprofessional Approach. Burlington, MA: Jones & Bartlett Learning. Shavit. I., Kofman, M., Leder, M., Hod, T., & Kozer, E. (2008). Observational pain assessment versus self-report in paediatric triage. Emergency Medicine Journal, 25 (9), 552-555. doi: 10.1136/emj.2008.058297 Simons, J., & Macdonald, L. (2006). Changing practice: implementing validated paediatric pain assessment tools. Journal of Child Health Care, 10 (2), 160-176. doi: 10.117/1367493506062555 Voepel-Lewis, T., Zanotti, J., Danmeyer, J., & Merkel, S. (2010). Reliability and validity of the Face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. American Journal of Critical Care, 19 (1), 55-62. doi: 10.4037/ajcc2010624 Willis, M., Merkel, S., Voepel-Lewis, T., & Malviva, S. (2003). FLACC Behavioral Pain Assessment Scale: a comparison with the child’s self-report. Pediatric Nursing, 29 (3),195-198. doi: Mary has just graduated from a BSN program. She has been offered a job on the pediatric unit at a small rural hospital. Although the hospital only has 65 beds, it does have a unit reserved for pediatric patients. Shortly after being hired to work on the ped units, Mary discovered that the staff used the FACE pain assessment tool for all patients on the unit. During her BSN program, Mary was familiar with the FLACC pain assessment tool. Mary is unsure as to which tool is the most valid and reliable for small children. The highest level of evidence we found was a case-control study, and it supported our focused question by concluding that the FLACC pain assessment tool offers a greater population application. We reviewed the research and conclude that both the FLACC and the FACE are valid and reliable tools in pain assessment of a pediatric population; however, according to evidence-based research, FLACC is the most appropriate and reliable pain assessment tool for children less than 3 years of age. PPAARE ComponentCase Example Problem Pain Assessment tool validity and reliability PatientPediatric Patients in Rural Hospital Action Diagnostic intervention regarding pain assessment using the FLACC tool Alternative Standard diagnostic intervention using the FACE tool Patient ResultsAccurate assessment of pain Level of EvidenceCase studies, case reports, editorials, expert opinions RELEVANT EVIDENCE The databases we used include: CINAHL Cochrane Library ProQuest. We began the search by finding articles related to pain assessment in the pediatric population and narrowed it down to a rural area. Key words: FLACC pain assessment tool FACE pain assessment tool rural hospital pediatric population. EVIDENCE APPRAISAL We chose two of our resources to appraise for trustworthiness, reliability, and validity. Qualitative study Purpose: to further validate the FLACC tool by comparing the assigned scores to the child’s self- report of pain Sample: Post-op patients, aged 3 – 7 Conclusion: The FLACC is a valid tool as a measure in post-op pain in a pediatric population Quantitative study Purpose: Address a lack of evidence-based pain management by implementing validated pain assessment tools Sample: Survey of nurses: 23 at 6 months, 20 at 12 months Conclusion: Even when nurses consider that a new intervention is necessary, there are obstacles to implementing change.