539 - Changes in pain assessment, documentation and treatment with integrative modalities after launching an integrative medicine service at a tertiary children’s hospital

Publication Number: 539.4206

Nadia Roessler De Angulo, University of California, San Francisco, SAN FRANCISCO, CA, United States; Stefan J. Friedrichsdorf, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Andrea C. Postier, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Lisa Purser, UCSF Benioff Childrens Hospitals, San Francisco, CA, United States; Barbette Murphy, University of California, San Francisco, School of Medicine, Oakland, CA, United States; Julia R. Wolf, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Kristen Beckler, UCSF Benioff Children's Hospital San Francisco, Pacifica, CA, United States

Background: Many hospitalized children experience acute pain, which is still widely under-recognized, under-documented and under-treated.

Objective: Our objective was to compare pain prevalence and documentation, use of non-pharmacologic/integrative modalities for pain, and patient experiences in children admitted to a US children’s hospital, before and after the launch of an integrative medicine service.

Design/Methods: This cross-sectional mixed-method survey was carried out over 2-4 days in 2018 and in 2023. For all patients admitted for more than 24 hours, charts were reviewed for demographics, and, over the preceding day, modalities of pain assessment and treatment. All patients/caregivers admitted for 24 hours were surveyed regarding their experience. Descriptive statistics, association tests and qualitative thematic analysis were performed.

Results: Chart review: In 2018, 107 patient charts were reviewed and 39 patients interviewed, vs. 234 and 138 in 2023. All patients had at least one pain score documented in the past 24 hours in 2018; in 2023 96.3% of patients had at least 1 assessment (median 8 in 2018 vs. 7 in 2023, range 1-22 in 2023 vs. 0-24). Presence of pain was documented in 43.9% (2018) vs. 43.5% (2023) of patients. A comprehensive pain assessment was completed within 24 hours of admission in 45.8% vs. 33.9% (2023) of patients. A pain/palliative/IM consultation was placed in 15.9% (2018) vs. 25.6% (2023) of patients. Integrative modalities were documented in 39/107 (36.4%) in 2018 vs. 98/246 (39.8%) in 2023. The most frequently used modalities were repositioning/holding, distraction/music, emotional support/presence in both 2018 and 2023. In 2023, patients had a mean of 2.8 allied health professionals (child life, physical, integrative, or music therapists, etc.) involved in their care. Patient survey: Patients were satisfied with their pain management in 87.0% of cases (2018) vs. 87.4% (2023). There was no association between level of worst pain (mild, moderate, severe) documented and reported pain in 2018. In 2023, 45% of surveyed patients reported pain that was not documented in their chart.

Conclusion(s): Pain documentation continues to be incomplete, and does not correlate well with patients’ experiences. After launching an IM service, consults to the pain/palliative/IM service and use of IM modalities increased.