Effect of a pain identification intervention on improving pain assessment and management in the pediatric emergency department

Study objectives: We determine whether a red wrist band identifying pediatric patients treated in the emergency department (ED) with pain scores of 6 on a 0 to 10 scale improved health care provider assessment and treatment of pain.

Methods: A continuous sample of health care provider encounters with children (3 to 17 years) who presented to the nursing triage window of an urban public hospital pediatric ED, with a self-reported pain score of 6 out of 10, were studied. The study was run in 3 phases: the baseline phase (weeks 1 to 2), during which no intervention was applied; the intervention phase (weeks 3 to 8), which alternated intervention (red wrist band placed) weeks (3, 5, 7) with control (no red wrist band placed) weeks (4, 6, 8); and the washout phase (weeks 9 to 10), during which red band placement was ceased.

Results: Data from 435 patient visits (patient demographics: mean age 11.9±3.2 years, 51% male patients, 49% female patients) were collected and analyzed. During weeks 3 to 8 (119 intervention patients, 197 control patients) results were as follows: pain score assessed or documented by health care provider, 37% intervention visits, 38% control visits; pain medication given in ED, 52% intervention visits, 53% control visits; pain medication recommended or prescribed for home, 46% intervention visits, 49% control visits (P=NS for all outcomes). No significant differences were found in outcomes when baseline, intervention, and washout periods were compared.

Conclusion: We found no difference in health care provider behavior when a red wrist band was placed compared with when no red band was placed.

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