Pain after paediatric surgery is hard to assess and often under treated both in hospital and at home. This quality improvement project aims to audit the current practices with perioperative analgesia usage and identify areas of improvement.
To increase prescribing and administration of analgesia in paediatric day case dental surgery. Based on the standard that all day case patients should receive paracetamol and a non-steroidal anti inflammatory (NSAID) prior to discharge
Data was collected retrospectively from electronic patient records on 100 consecutive paediatric patients undergoing dental surgery between the February 2020 to March 2020. No exclusion criteria were used.
Weight adjusted doses of intraoperative analgesia.
Note: One patient received intraoperative morphine at a dose of 0.045 mg/kg
Postoperative prescribing and administration of analgesia.
Compared to previous years there has been an increase in the appropriate prescribing of NSAIDs; however, there was a decrease in perioperative administration. Paracetamol was given to 100% of patients in the perioperative period. Only two patients required postoperative morphine. Pain scores in both recovery and the step down ward were acceptable with over 90% having mild to no pain (pain score of 0-3). Limitations of this audit include; retrospective design, difficulty in assessing pain scores and patients being only followed up to hospital discharge.
In the Comparison to previous years graphs a significant improvement in NSAID administration was seen from 2016 to 2017; this was the result of targeted nurse education. This will be an intervention used in this audit cycle. Other change ideas include reviewing and improving the current ‘Day Case Analgesia’ patient information.
This dataset shows perioperative administration of NSAIDs needs to be improved to reach the audit standard. This will be improved by nurse education and development of an improved flyer. After these interventions a re-audit will be completed.
