Barriers to adequate analgesia in paediatric burns patients
All children with burn injuries experience pain at some time during their management and recovery. Burn pain is challenging to manage, owing to a combination of factors. The process of achieving adequate analgesia involves the correct scripting of medication based on the doctor's knowledge, the...
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| Veröffentlicht in: | South African medical journal 2020-10, Vol.110 (10), p.1032-1035 |
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| creator | Wall, S L Clarke, D L Nauhaus, H Allorto, N L |
| description | All children with burn injuries experience pain at some time during their management and recovery. Burn pain is challenging to manage, owing to a combination of factors. The process of achieving adequate analgesia involves the correct scripting of medication based on the doctor's knowledge, the correct fulfilling of that script, and patient compliance.
To assess two components of this process, correct scripting of medication based on the doctor's knowledge and the correct filling of that script, to highlight potential barriers to adequate analgesia for burn-injured patients being followed up at an outpatient department. Patient compliance was out of the scope of this study.
The study was conducted in the Pietermaritzburg Burn Service (PBS) in Pietermaritzburg, South Africa, and was undertaken in two parts. The first part was conducted through an anonymous, voluntary questionnaire completed by doctors working in hospitals referring to the PBS. The aim of the questionnaire was to identify deficits in knowledge of doctors regarding background analgesia for burn-injured children. The second part was conducted through an audit of the outpatient folders of children attending the PBS outpatient clinic to identify discrepancies between analgesia prescribed and analgesia supplied to the patient.
Thirty-six doctors completed the questionnaire. While nearly all the doctors prescribed background analgesia, just over half (58%) prescribed paracetamol, and of those, only half prescribed the correct dose. Half of the doctors prescribed tilidine, and only half of them knew the correct dose. Forty-seven percent of the doctors prescribed both paracetamol and tilidine for background analgesia. The outpatient folders of 59 children attending the outpatient clinic were audited. Fifty-three patients were prescribed paracetamol. There was a statistically significant difference between the paracetamol volume prescribed and the volume supplied (p |
| doi_str_mv | 10.7196/SAMJ.2020.v110i10.14519 |
| format | Article |
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To assess two components of this process, correct scripting of medication based on the doctor's knowledge and the correct filling of that script, to highlight potential barriers to adequate analgesia for burn-injured patients being followed up at an outpatient department. Patient compliance was out of the scope of this study.
The study was conducted in the Pietermaritzburg Burn Service (PBS) in Pietermaritzburg, South Africa, and was undertaken in two parts. The first part was conducted through an anonymous, voluntary questionnaire completed by doctors working in hospitals referring to the PBS. The aim of the questionnaire was to identify deficits in knowledge of doctors regarding background analgesia for burn-injured children. The second part was conducted through an audit of the outpatient folders of children attending the PBS outpatient clinic to identify discrepancies between analgesia prescribed and analgesia supplied to the patient.
Thirty-six doctors completed the questionnaire. While nearly all the doctors prescribed background analgesia, just over half (58%) prescribed paracetamol, and of those, only half prescribed the correct dose. Half of the doctors prescribed tilidine, and only half of them knew the correct dose. Forty-seven percent of the doctors prescribed both paracetamol and tilidine for background analgesia. The outpatient folders of 59 children attending the outpatient clinic were audited. Fifty-three patients were prescribed paracetamol. There was a statistically significant difference between the paracetamol volume prescribed and the volume supplied (p<0.0001). Twenty-four patients were prescribed ibuprofen. There was a statistically significant difference between the ibuprofen volume prescribed and the volume supplied (p<0.0001).
Burn-injured children commonly receive inadequate analgesia in our setting. The reasons for this are multifactorial. The correct dose and the correct drugs for burn-related background pain are deficits in the knowledge of doctors who deal with this common problem. Furthermore, even if the correct drug and dose are prescribed, the correct volume of medication is often not issued by the pharmacy. This study highlights barriers to achieving adequate analgesia in children with burns being managed as outpatients. Potential strategies to overcome barriers include improving education with regard to pain management and burns at an undergraduate and postgraduate level, and improved supply chain management.</description><identifier>ISSN: 0256-9574</identifier><identifier>EISSN: 2078-5135</identifier><identifier>DOI: 10.7196/SAMJ.2020.v110i10.14519</identifier><identifier>PMID: 33205734</identifier><language>eng</language><publisher>South Africa: Health & Medical Publishing Group</publisher><subject>Acetaminophen - administration & dosage ; Acetaminophen - therapeutic use ; Analgesia ; Analgesics, Non-Narcotic - administration & dosage ; Analgesics, Non-Narcotic - therapeutic use ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - therapeutic use ; Burns ; Burns - complications ; Causes of ; Child ; Child, Preschool ; Clinical Competence ; Complications and side effects ; Drug Administration Schedule ; Drug therapy ; Female ; Humans ; Ibuprofen - administration & dosage ; Ibuprofen - therapeutic use ; Infant ; Male ; Management ; Medication Adherence ; Pain Management - methods ; Pediatric injuries ; Pediatric pain ; Pediatric research ; Practice Patterns, Physicians ; South Africa ; Tilidine - administration & dosage ; Tilidine - therapeutic use</subject><ispartof>South African medical journal, 2020-10, Vol.110 (10), p.1032-1035</ispartof><rights>COPYRIGHT 2020 Health & Medical Publishing Group</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c344t-bdc9566ec3683f0c3437f658e30994e10b93b8b60fb2b86ccb7af9fdd91954c53</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,864,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33205734$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wall, S L</creatorcontrib><creatorcontrib>Clarke, D L</creatorcontrib><creatorcontrib>Nauhaus, H</creatorcontrib><creatorcontrib>Allorto, N L</creatorcontrib><title>Barriers to adequate analgesia in paediatric burns patients</title><title>South African medical journal</title><addtitle>S Afr Med J</addtitle><description>All children with burn injuries experience pain at some time during their management and recovery. Burn pain is challenging to manage, owing to a combination of factors. The process of achieving adequate analgesia involves the correct scripting of medication based on the doctor's knowledge, the correct fulfilling of that script, and patient compliance.
To assess two components of this process, correct scripting of medication based on the doctor's knowledge and the correct filling of that script, to highlight potential barriers to adequate analgesia for burn-injured patients being followed up at an outpatient department. Patient compliance was out of the scope of this study.
The study was conducted in the Pietermaritzburg Burn Service (PBS) in Pietermaritzburg, South Africa, and was undertaken in two parts. The first part was conducted through an anonymous, voluntary questionnaire completed by doctors working in hospitals referring to the PBS. The aim of the questionnaire was to identify deficits in knowledge of doctors regarding background analgesia for burn-injured children. The second part was conducted through an audit of the outpatient folders of children attending the PBS outpatient clinic to identify discrepancies between analgesia prescribed and analgesia supplied to the patient.
Thirty-six doctors completed the questionnaire. While nearly all the doctors prescribed background analgesia, just over half (58%) prescribed paracetamol, and of those, only half prescribed the correct dose. Half of the doctors prescribed tilidine, and only half of them knew the correct dose. Forty-seven percent of the doctors prescribed both paracetamol and tilidine for background analgesia. The outpatient folders of 59 children attending the outpatient clinic were audited. Fifty-three patients were prescribed paracetamol. There was a statistically significant difference between the paracetamol volume prescribed and the volume supplied (p<0.0001). Twenty-four patients were prescribed ibuprofen. There was a statistically significant difference between the ibuprofen volume prescribed and the volume supplied (p<0.0001).
Burn-injured children commonly receive inadequate analgesia in our setting. The reasons for this are multifactorial. The correct dose and the correct drugs for burn-related background pain are deficits in the knowledge of doctors who deal with this common problem. Furthermore, even if the correct drug and dose are prescribed, the correct volume of medication is often not issued by the pharmacy. This study highlights barriers to achieving adequate analgesia in children with burns being managed as outpatients. Potential strategies to overcome barriers include improving education with regard to pain management and burns at an undergraduate and postgraduate level, and improved supply chain management.</description><subject>Acetaminophen - administration & dosage</subject><subject>Acetaminophen - therapeutic use</subject><subject>Analgesia</subject><subject>Analgesics, Non-Narcotic - administration & dosage</subject><subject>Analgesics, Non-Narcotic - therapeutic use</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Burns</subject><subject>Burns - complications</subject><subject>Causes of</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical Competence</subject><subject>Complications and side effects</subject><subject>Drug Administration Schedule</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Ibuprofen - administration & dosage</subject><subject>Ibuprofen - therapeutic use</subject><subject>Infant</subject><subject>Male</subject><subject>Management</subject><subject>Medication Adherence</subject><subject>Pain Management - methods</subject><subject>Pediatric injuries</subject><subject>Pediatric pain</subject><subject>Pediatric research</subject><subject>Practice Patterns, Physicians</subject><subject>South Africa</subject><subject>Tilidine - administration & dosage</subject><subject>Tilidine - therapeutic use</subject><issn>0256-9574</issn><issn>2078-5135</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kEtLAzEUhYMottT-BZ2VuJmadya4quITxYW6DknmjgamMzXJCP57p7Z6NwcO51wOH0InBC8U0fL8Zfn0sKCY4sUXITiMNuGC6D00pVhVpSBM7KMppkKWWig-QfOUgsOUKiW45odowhjFQjE-RReXNsYAMRW5L2wNn4PNUNjOtu-Qgi1CV6wt1MHmGHzhhtil0cgBupyO0EFj2wTznc7Q283169Vd-fh8e3-1fCw94zyXrvZaSAmeyYo1eDSZaqSogGGtORDsNHOVk7hx1FXSe6dso5u61kQL7gWbobPt33XsPwdI2axC8tC2toN-SIZySSrJNjdDp9vou23BfIBt80fq2yGHvktmKTnhFI9rxqDaBn3sU4rQmHUMKxu_DcFmQ9lsKJsNZbOjbH4pj83j3ZrBraD-7_0xZT_oeHgO</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Wall, S L</creator><creator>Clarke, D L</creator><creator>Nauhaus, H</creator><creator>Allorto, N L</creator><general>Health & Medical Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20201001</creationdate><title>Barriers to adequate analgesia in paediatric burns patients</title><author>Wall, S L ; Clarke, D L ; Nauhaus, H ; Allorto, N L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c344t-bdc9566ec3683f0c3437f658e30994e10b93b8b60fb2b86ccb7af9fdd91954c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acetaminophen - administration & dosage</topic><topic>Acetaminophen - therapeutic use</topic><topic>Analgesia</topic><topic>Analgesics, Non-Narcotic - administration & dosage</topic><topic>Analgesics, Non-Narcotic - therapeutic use</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Burns</topic><topic>Burns - complications</topic><topic>Causes of</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Clinical Competence</topic><topic>Complications and side effects</topic><topic>Drug Administration Schedule</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Ibuprofen - administration & dosage</topic><topic>Ibuprofen - therapeutic use</topic><topic>Infant</topic><topic>Male</topic><topic>Management</topic><topic>Medication Adherence</topic><topic>Pain Management - methods</topic><topic>Pediatric injuries</topic><topic>Pediatric pain</topic><topic>Pediatric research</topic><topic>Practice Patterns, Physicians</topic><topic>South Africa</topic><topic>Tilidine - administration & dosage</topic><topic>Tilidine - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wall, S L</creatorcontrib><creatorcontrib>Clarke, D L</creatorcontrib><creatorcontrib>Nauhaus, H</creatorcontrib><creatorcontrib>Allorto, N L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>South African medical journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wall, S L</au><au>Clarke, D L</au><au>Nauhaus, H</au><au>Allorto, N L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Barriers to adequate analgesia in paediatric burns patients</atitle><jtitle>South African medical journal</jtitle><addtitle>S Afr Med J</addtitle><date>2020-10-01</date><risdate>2020</risdate><volume>110</volume><issue>10</issue><spage>1032</spage><epage>1035</epage><pages>1032-1035</pages><issn>0256-9574</issn><eissn>2078-5135</eissn><abstract>All children with burn injuries experience pain at some time during their management and recovery. Burn pain is challenging to manage, owing to a combination of factors. The process of achieving adequate analgesia involves the correct scripting of medication based on the doctor's knowledge, the correct fulfilling of that script, and patient compliance.
To assess two components of this process, correct scripting of medication based on the doctor's knowledge and the correct filling of that script, to highlight potential barriers to adequate analgesia for burn-injured patients being followed up at an outpatient department. Patient compliance was out of the scope of this study.
The study was conducted in the Pietermaritzburg Burn Service (PBS) in Pietermaritzburg, South Africa, and was undertaken in two parts. The first part was conducted through an anonymous, voluntary questionnaire completed by doctors working in hospitals referring to the PBS. The aim of the questionnaire was to identify deficits in knowledge of doctors regarding background analgesia for burn-injured children. The second part was conducted through an audit of the outpatient folders of children attending the PBS outpatient clinic to identify discrepancies between analgesia prescribed and analgesia supplied to the patient.
Thirty-six doctors completed the questionnaire. While nearly all the doctors prescribed background analgesia, just over half (58%) prescribed paracetamol, and of those, only half prescribed the correct dose. Half of the doctors prescribed tilidine, and only half of them knew the correct dose. Forty-seven percent of the doctors prescribed both paracetamol and tilidine for background analgesia. The outpatient folders of 59 children attending the outpatient clinic were audited. Fifty-three patients were prescribed paracetamol. There was a statistically significant difference between the paracetamol volume prescribed and the volume supplied (p<0.0001). Twenty-four patients were prescribed ibuprofen. There was a statistically significant difference between the ibuprofen volume prescribed and the volume supplied (p<0.0001).
Burn-injured children commonly receive inadequate analgesia in our setting. The reasons for this are multifactorial. The correct dose and the correct drugs for burn-related background pain are deficits in the knowledge of doctors who deal with this common problem. Furthermore, even if the correct drug and dose are prescribed, the correct volume of medication is often not issued by the pharmacy. This study highlights barriers to achieving adequate analgesia in children with burns being managed as outpatients. Potential strategies to overcome barriers include improving education with regard to pain management and burns at an undergraduate and postgraduate level, and improved supply chain management.</abstract><cop>South Africa</cop><pub>Health & Medical Publishing Group</pub><pmid>33205734</pmid><doi>10.7196/SAMJ.2020.v110i10.14519</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; African Journals Online (Open Access); Sabinet African Journals Open Access Collection; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Acetaminophen - administration & dosage Acetaminophen - therapeutic use Analgesia Analgesics, Non-Narcotic - administration & dosage Analgesics, Non-Narcotic - therapeutic use Analgesics, Opioid - administration & dosage Analgesics, Opioid - therapeutic use Burns Burns - complications Causes of Child Child, Preschool Clinical Competence Complications and side effects Drug Administration Schedule Drug therapy Female Humans Ibuprofen - administration & dosage Ibuprofen - therapeutic use Infant Male Management Medication Adherence Pain Management - methods Pediatric injuries Pediatric pain Pediatric research Practice Patterns, Physicians South Africa Tilidine - administration & dosage Tilidine - therapeutic use |
| title | Barriers to adequate analgesia in paediatric burns patients |
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