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Clinical Quality and Patient SafetyPain Management
In the pre-hospital environment, pain is one of the most frequently encountered symptoms, resulting from a wide variety of injuries and illnesses. As recently as a decade ago, health professionals believed that children had less capacity than adults to feel and remember pain. This inaccurate assumption led to inadequate treatment and unnecessary suffering; analgesia in children has consistently been inferior to that in adults. Ambulance clinicians now have more tools in their analgesic armoury than ever before. However, improvements will only occur when pain becomes recognised as a pre-hospital priority, and every patient receives the most effective pain relief that can safely be delivered. Improvements are required in the recognition and assessment of pain and the pharmacological and non-pharmacological approaches that are utilised. Increasing our knowledge of pain management is simply not enough. No clinician would unnecessarily inflict pain, yet poor pain management is akin to just that. The old adage ‘No pain, no gain’ is simply not true for paediatric patients; pain can and will kill. We must all make a sustained effort to question our current practice, examine our professional values and elevate the management of pain to become a pre-hospital priority. Pain is a subjective, individual phenomenon. Unlike taking a pulse rate or measuring blood pressure, humans do not have an inbuilt reliable physiological indicator of pain. The lack of a conveniently placed pain dial, makes the assessment and management of pain particularly challenging. Over the last two decades, significant advances have been made in the understanding of and management of paediatric pain. However, the explosion in research has not translated into significant improvements in clinical practice. Children's pain is still not being managed effectively. Pre-hospital analgesia has developed from entonox in the 1970’s to Nalbuphine Hydrochloride during the 1990’s and finally Morphine Sulphate in the 2000’s. With the introduction of oral morphine during 2006, Dorset Ambulance NHS Trust set out on a mission to ensure that every patient received the most effective pain relief that could safely be delivered. As part of a significant education initiative, the Paediatric Pain booklet was distributed to all staff, combined with the latest on-line resources.
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