Aim To improve the initial pain assessment and then reassessment of children presenting to the A and E department to meet current standards.

Method Using the model for improvement we performed several PDSA cycles with continual data collection to observe the effects of our interventions over time. Our interventions included an interactive pain scoring leaflet given to parents, identifying a paediatric nurse ‘Pain Champion’ in the department, visual reminders to the clinical staff, triage checklists for the nurses including pain scoring and including pain scoring teaching as part of a new educational package for both A and E and Paediatric junior doctors rotating into the department.

Results Our initial analysis of the problem demonstrated that only 35% of children presenting to A and E with minor injuries were having a pain score documented. Furthermore, only 24% had evidence of any reassessment of pain.

As the table above shows, over time as we introduced more of our interventions, we saw the documentation of initial pain assessment and subsequent reassessment start to increase.

Conclusions To successfully start to influence a change in practice, multiple interventions may be needed, as was the case with our project. These changes targeted all the different stakeholders including engaging parents and children as well as the clinical staff. We found that identifying a ‘pain champion’ in the department was essential for sustaining changes in practice and for engaging other stake holders.

We plan to continue to implement our changes and continue this project and by doing so we hope to further improve the assessment and reassessment of pain in children presenting to A and E.