• Jeffrey R Avansino, Lisa M Peters, Shellie L Stockfish, and Gary A Walco.
• Department of Surgery, University of Washington, Division of Surgery, Seattle Children's Hospital, Seattle, WA 98105-0371, USA. jeffrey.avansino@seattlechildrens.org
• Pediatrics. 2013 Mar 1;131(3):e921-7.

ObjectiveUndertreating pain and inappropriate use of opioids are potentially harmful to patients. We created a reliable process to discuss the pain plan preoperatively, hypothesizing that it will enhance the safety of opioid administration while improving the quality of pain management.MethodsA multidisciplinary group was convened for a 3-day workshop where a reliable method for preoperative discussion of the pain plan was created for patients having ambulatory hernia repair. Four targets were defined: (1) pain management is discussed by the provider; (2) a pain plan is accurately documented in the electronic medical record; (3) parents perceive that pain is adequately discussed; and (4) behavioral indicators demonstrate the pain plan is effective. The goal was 100% compliance with targets at 60 days. A standard pain regimen was created. Data collection included chart review and a postoperative phone call. Patients were separated into 30-day postimplementation cohorts for evaluation of their hernia. Analysis was descriptive.ResultsA total of 235 patients had hernia repair. Discussion and documentation of pain occurred in 73% at 240 days (n = 15). Providers entered orders for postoperative pain in 80% at 240 days after implementation. Parents reported that pain was adequately discussed and treated between 87% and 100% of the time.ConclusionsBalancing the potential harm from undertreating pain and inappropriate use of opioids requires an evidence-based, multidisciplinary family-centered approach. The development and implementation of a reliable method for the management and treatment of pain reduces variability allowing for delivery of safe and quality care.

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