Children's Pain and Distress at a Public Influenza Vaccination Clinic: A Parent Survey and Public Observation Study.

Immunizations are a necessary but distressing and painful procedure that most infants and children regularly undergo. Each year, a tertiary pediatric hospital in Canada holds an influenza vaccination clinic for all staff and their families. Evidence-based interventions to reduce pain and distress in babies and children are used. Despite this, infants and children continue to be distressed throughout the vaccination procedure. The objectives of this study were to: (1) measure the prevalence of distress among infants and children before, during, and after vaccine administration at the clinic, and (2) evaluate parents' perception of their child(ren)'s distress before, during, and after vaccine administration and the effectiveness of pain management interventions used during the clinic. A cross-sectional design of naturalistic observation and parent surveys was used and data was analyzed using descriptive statistics. A total of 283 children between 6 months and 18 years were vaccinated at the clinic, with 52% observed to be distressed before, during, or after the procedure. There were 115 parents of 206 children that completed the survey; 47% of these parents perceived that their children were distressed before, during, or after vaccination, and 42% perceived that the pain treatments used for their child(ren) were very effective. The results of this study will continue to inform interventions for needle-related pain and distress management, as well as improvements for future public vaccination clinics.

A Quality Improvement Project on Pain Management at a Tertiary Pediatric Hospital.

To assess and improve pain management practices for hospitalized children in an urban tertiary pediatric teaching hospital. METHODS: Health Quality Ontario Quality Improvement (QI) framework informed this study. A pre (T1) - post (T2) intervention assessment included chart reviews and children/caregiver surveys to ascertain pain management practices. Information on self-reported pain intensity, painful procedures, pain treatment and satisfaction were obtained from children/caregivers. Documented pain assessment, pain scores, and pharmacological/non-pharmacological pain treatments were collected by chart review. T1 data was fed back to pediatric units to inform their decisions and pain management targets. RESULTS: At T1, 51 (58% of eligible participants) children/caregivers participated. At T2, 86 (97%) chart reviews and 51 (54%) children/caregivers surveys were completed. Most children/caregivers at T1 (78%) and T2 (80%) reported moderate to severe pain during their hospitalization. A mean of 2.6 painful procedures were documented in the previous 24 h, with the most common being needle-related procedures at both T1 and T2. Pain management strategies were infrequently used during needle-related procedures at both time points. CONCLUSION: No improvements in pain management as measured by the T1 and T2 data occurred. Findings informed further pain management initiatives in the participating hospital.