The Acute pain service (APS) provides a multimodal approach for the prevention and treatment of acute pain with the goal of improving patient comfort and satisfaction in the perioperative as well as non-operative hospital settings. The APS works in collaboration with other specialty services that provide consultations for hospitalized children with pain.
For example, the service provides help with pain management of hospitalized children after major surgery and trauma as well as of hospitalized children with pain related to medical conditions such as sickle cell disease and mucositis from chemotherapy to name a few. In addition, the service offers strategies for weaning pain medications and difficult sedation.
The team is composed of anesthesiologists, an advanced practice nurse (1 FTE), a nurse clinician (0.6 FTE), a pharmacist, and respiratory technicians. All staff pediatric anesthesiologists contribute to 24/7 medical cover.
Clinical work:
All children have timely, individualized, safe and effective pain treatment achieved by:
- daily pain rounds
- standardized procedures, protocols, pre-printed orders, and documentation
- pre-operative assessments for complex patients/procedures
Common modalities used to manage acute pain include patient-controlled analgesia (PCA), epidural analgesia, continuous peripheral nerve blocks for in and out-patients, continuous and intermittent intravenous administration of various opioids.
Non-pharmacological strategies are offered in combination to medications and modalities.
Education and training:
Pain seminars are given to medical residents and fellows of different specialties. The advance practice nurse and the nurse clinician teach nurses and family. A general orientation for newly recruited nurses is available. The team leads the development and implementation of procedures that affect children at the MCH (e.g.WAT-1 scale, sedation scale).
Quality Improvement, Audit and Research:
The pain team handles complex projects mandated from the institution and the ministry (e.g., development of opioid guidelines, safe use of opioids in hospitalized patients, state of art documentation, collective orders (e.g., sucrose and topical), and ensures that performance goals are met. The team also works on transversal projects to develop strategies addressing pediatric pain in a broader perspective across the institution (e.g., Comfort Zone with needles, ERAS for pectus repair, sickle cell task force). Protocols and important information are available on the intranet: https://www.mymuhc.muhc.mcgill.ca/policies-and-procedures/clinical-pediatric-policies/clinical-policies-and-procedures-pediatric
