PEDIATRIC PAIN MANAGEMENT IN THE EMERGENCY DEPARTMENT:THE TRIAGE NURSES’ PERSPECTIVE Authors: Daina Thomas, MD, Janeva Kircher, MD, Amy C. Plint, MD, MSc, Eleanor Fitzpatrick, MN, RN, Amanda S. Newton, PhD, RN, Rhonda J. Rosychuk, PhD PStat, PStat(ASA), Simran Grewal, MD, and Samina Ali, MDCM, Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada Introduction: Understanding triage nurses' perspectives of pain management is essential for timely pain care for children in the emergency department. Objectives of this study were to describe the triage pain treatment protocols used, knowledge of pain management modalities, and barriers and attitudes towards implementation of pain treatment protocols. Methods: A paper-based survey was administered to all triage nurses at three Canadian pediatric emergency depart- ments, between December 2011 and January 2012. Results: The response rate was 86% (n=126/147). The mean respondent age was 40 years (standard deviation [SD] 9.3) with 8.6 years (SD 7.7) of triage experience. General triage emergency department (GTED) nurses rated adequacy of triage pain treatment lower than pediatric-only triage emergency department (PTED) nurses (P b .001). GTED nurses reported a longer acceptable delay between triage time and administra- tion of analgesia than PTED nurses (P b .002). Most nurses rated more comfort with a protocol involving administration of acetaminophen (97mm, interquartile range [IQR] 92, 99) or ibuprofen (97mm, IQR 93, 100) than for oral morphine (67mm, IQR 35, 94) or oxycodone (57mm, IQR 15, 81). The top three reported barriers to triage-initiated pain protocols were monitoring capability, time, and access to medications. Willingness to implement a triage-initiated pain protocol was rated as 81mm (IQR 71, 96). Discussion: Triage nurses are willing to implement pain protocols for children in the emergency department, but differences in comfort and experience exist between PTED and GTED nurses. Provision of triage initiated pain protocols and associated education may empower nurses to improve care for children in pain in the emergency department. Key words: Triage; Pediatrics; Pain; Protocol; Analgesia; Emergency department T he World Health Organization has declared that pediatric pain treatment is a public health concern of major significance. 1 Studies indicate that inadequate pain management during medical care can have numerous detrimental effects, including an extended length of stay, slower healing, and emotional trauma and suffering. 2–5 Furthermore, negative effects may extend into adulthood and can include fear of medical events or health RESEARCH Daina Thomas, is Pediatric Emergency Physician Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. Janeva Kircher, is Emergency Medicine Resident Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. Amy C. Plint, is Pediatric Emergency Physician Department of Pediatrics and Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Eleanor Fitzpatrick, is Research Coordinator Department of Emergency Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. Amanda S. Newton, is Associate Professor (Pediatrics) Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, and Women and Children’ s Health Research Institute, Edmonton, Alberta, Canada. Rhonda J. Rosychuk, Professor (Pediatrics) and Statistician Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, and Women and Children’ s Health Research Institute, Edmonton, Alberta, Canada. Simran Grewal, is Divisional Director Division of Pediatric Emergency, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. Samina Ali, is Pediatric Emergency Physician Departments of Pediatrics and Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, and Women and Children’s Health Research Institute, Edmonton, Alberta, Canada. This study was funded by a Women and Children’s Health Research Institute (Edmonton, Alberta, Canada) Trainee Grant, secured by Dr Thomas. Dr Rosychuk is salary supported by Alberta Innovates–Health Solutions (Edmonton, Alberta, Canada) as a Health Scholar. Dr Newton is salary supported by the Canadian Institutes of Health Research. Dr Plint holds a University of Ottawa Faculty of Medicine Research Chair in Pediatric Emergency Medicine. For correspondence, write: Samina Ali, MDCM, Department of Pediatrics, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Canada AB T6G 1C9; E-mail: sali@ualberta.ca. J Emerg Nurs ■. 0099-1767 Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2015.02.012 ■ ■ • ■ WWW.JENONLINE.ORG 1 Master Proof ymen2745.pdf