TABLE 4.

Changes since the review

Hospital philosophy
Procedural pain management identified as a key focus for improvement by the Hospital Executive
Formulation and implementation of guidelines to reduce procedure-related pain and distress
New procedure rooms child-friendly
Observation charts
Inclusion of pain assessment as the fifth vital sign
Education posters (aimed at parents and staff)
Use of topical anesthetic cream
Oral sucrose for infants
Nonpharmacological strategies
Clinical resources
Establishment of multidisciplinary persistent pain clinic
Additional Clinical Nurse Consultant appointed
Additional Pain Medicine Specialist appointed
Accreditation for training by the Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists
Additional Child Life Specialists appointed
Pain assessment tools
FLACC scale, Numeric Rating Scale and Wong-Baker Faces Scale
Disseminated throughout the hospital
Laminated tools fit onto staff identification badges
Pain assessment tool for neonates
Education and awareness raising
Annual Pain Awareness Week implemented
Increased referrals to the pain management service
Increased staff education
Increasing “non pain service” clinical staff involvement in improving pain management
College guidelines
RCH staff instrumental in formulating RACP guidelines on procedural pain management in children (published October 2005)

FLACC Faces, Legs, Activity, Cry and Consolability; RACP Royal Australasian College of Physicians; RCH Royal Children’s Hospital