(141) Nonpharmacological Pain Interventions in the Pediatric Intensive Care Unit: Who Receives What?

Abstract

The majority of patients in the pediatric intensive care unit (PICU) experience pain daily, whether from their critical illness, therapies provided, and/or diagnostic procedures. Effective pain management is essential for this vulnerable population. Nonpharmacological interventions are indicated for pain management in children and may augment the effectiveness or even reduce the need for pharmacologic management. However, there is limited information on how nonpharmacological interventions are utilized in the PICU. To address this gap, a secondary data analysis was performed to determine what nonpharmacological interventions were recorded in the electronic health (EHR) record and patterns in use by patient demographics. Data were extracted from a 24-hour observational cohort study conducted in 15 PICUs. Of 220 eligible patients, 97 (44%) had nonpharmacological interventions recorded in their EHR. The most frequently recorded modalities for those 97 patients included repositioning (65%), decreasing environmental stimuli (55%), caregiver presence (37%), distraction (23%), and music therapy (20%). Differences in nonpharmacological interventions were examined using Fisher's exact test. Application of interventions did not differ by sex, race, diagnostic category, length of stay, communicative ability, mechanical ventilation, or neuromuscular blockade. Repositioning was provided more often for patients receiving a sedative (77% v. 49%, p = .005). Patients receiving a sedative were also more likely to receive music therapy (27% v. 10%, p = .042), as were patients under 2 years old (30% v. 7%, p = .004). Decreasing environmental stimuli was most often provided for patients with no pain documented (72%) as compared to those with mild pain (38%) or moderate/severe pain (42%) documented (p = .010). Findings indicate that nonpharmacological pain management may be under-documented and/or underutilized in the PICU and is applied inconsistently across populations. Further research is needed to determine how nurses decide to apply these interventions and whether they are effective in managing pediatric pain.