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SERVICE EVALUATION OF A NEW REGIONAL BASED PAEDIATRIC SPASTICITY MANAGEMENT CLINIC AT ENABLE IRELAND & UNIVERSITY HOSPITAL GALWAY, IRELAND
Introduction: The spasticity management clinic was developed to ensure children in the West of Ireland have timely access to a service in their own community which improves their comfort, mobility and quality of life. Prior to February 2019 families had to travel to Dublin to avail of this service.
AIMS: To assess parent satisfaction with the paediatric spasticity management clinic since the establishment of the service in February 2019 and to seek feedback guiding service improvement and development.
METHODS: Between February and October 2019, parents of patients availing of the service, were invited to complete a pre- and post-injection questionnaire, outlining their goals for treatment. Goals were categorised using the International Classification of Functioning, Disability and Health.
RESULTS: 16 patients, aged between 5 and 18years, had botulinum toxin administered. Of those, 62.5% reported all of their goals were “achieved” and 37.5% reported one of their goals to be “partially achieved” and the other goals “achieved”. All parents reported being “very satisfied” with the service; mean satisfaction 4.8/5, using The Likert scale. The most common reason for satisfaction was ease of access and the proximity of the clinic to the patients’ homes.
CONCLUSION: Patients and parents have a preference for availing of a regional based service and overall, are very satisfied with the multi-disciplinary approach and clinical outcomes. Further resourcing would expand the service, thus providing local care for patients in the western region of Ireland, with benefits for patients, their families and a reduction of demands on the large tertiary centres.
THE COMFORT PROMISE IN A CANADIAN TERTIARY CARE EMERGENCY DEPARTMENT: A QUALITY IMPROVEMENT STUDY
Pain is the number one reason children visit the hospital. The Comfort PromiseTM is an institution-wide quality improvement initiative adopted by several North American paediatric tertiary centres. The purpose of this ongoing study is to determine the clinical impact of The Comfort PromiseTM.
Focus groups of healthcare professionals were assembled to initiate a root cause analysis for pain intervention in the paediatric ED. A medical record review of all patients (0-17 years) who presented to the Children’s Hospital paediatric ED from January 2019 to December 2019 is being conducted. We report the results to date. Binary primary outcomes include (i) the proportion of children with a verbal Numerical Rating Score (vNRS) > 3 or a Faces Pain Scale – Revised (FPS-R) > 2 at discharge for children with presenting pain and (ii) the proportion of children receiving The Comfort PromiseTM bundle (distraction, topical anesthetic, sucrose, and comfort positioning) undergoing needle-related procedures.
Ninety medical records have been reviewed. The mean (SD) age is 8.3 (6) years. 26/90 (29%) presented with a painful condition and 14/90 (16%) had a painful procedure in the ED. A pain score at triage was documented in 12/26 (47%) and analgesia was offered in 1/26 (4%). Among patients who underwent a needle-related procedure, analgesia was documented in 1/14 (7%).
Preliminary results suggest that assessment of pain and provision of analgesia is either poorly documented or suboptimally administered. Knowledge mobilization strategies such as The Comfort PromiseTM should address these factors to improve care delivery.