A map on hospital wards helps to detect and control pain of admitted patients

Pain has become the fifth vital sign that staff at the SJD Barcelona Children's Hospital monitor and measure in admitted patients—several times per day—with the aim of detecting and treating pain as quickly as possible.

‘Controlling or minimising pain helps to alleviate feelings of anxiety that hospitalised children feel, as well as their parents, and that has a direct effect on their recovery. Several studies have shown that better pain management reduces the number of days a patient stays in hospital,’ explains Laura Monfort, Pediatrician on the Pain Unit at the SJD Barcelona Children's Hospital.

Every hospital ward has had a pain map installed: a screen that shows real-time, colour-coded data on patient pain and its intensity. Green means no pain, amber means mild pain, and red means moderate to intense pain.

‘Detecting pain is complicated because it is very subjective. Plus, there is added complexity in pediatrics, as we also treat children that cannot talk, whether due to their age or because of their specific disease. This makes it hard to establish if they are in pain and how intense it is. That is why we assess pain using specially designed scales validated for use with pediatric patients. For newborns, for example, we have to go by their behaviour and cry. Some children are too young to know numbers and use a scale of one to ten. At the hospital, we have several scales that children can use to express themselves, according to their capabilities,’ notes Monfort.

These assessments are carried out systematically every eight hours for all hospitalised patients and they are added to the computing system in real time. On the one hand, this is to ensure that they are recorded in the patient’s medical history, and on the other hand, it ensures that the patient's location on the ward is added to the ward’s pain map, allowing staff to properly monitor their pain.

Additionally, one of the specialised nurses, Mónica Rebordosa, checks the pain map of every hospital ward once per day, the central hub of which is a control centre called Còrtex. Mónica Rebordosa identifies which patients are in the most pain, allowing their treatment to be optimised.

The pain map was implemented at the SJD Barcelona Children's Hospital after a successful pilot study conducted in wards ten and seven of the hospital – the pediatric ward and the maternity ward, respectively. In February 2023, it was expanded to include all of the wards at the SJD Barcelona Children's Hospital, as well as the SJD Pediatric Cancer Center Barcelona.

Controlling pain during small procedures

The SJD Barcelona Children's Hospital is one of the leading hospital facilities in the implementation of these types of healthcare tools in Spain. In 2009, a commission was created with the primary goal of minimising pain and discomfort associated with hospital admission.

Among other measures, this commission implemented the use of patient-controlled analgesia (PCA) morphine infusion pumps to control post-surgical pain after Caesareans, hysterectomies and complex pediatric operations, and also a distraction kit with toys for children of all ages to keep them occupied during procedures and help them not notice pain and discomfort as much.

In cases where the distraction kit is not enough, the specialised pain nurse is tasked with helping children who are scared or anxious during small procedures, such as inserting a central line or a catheter, taking a blood sample or performing a lumbar puncture. 

In these cases, the nurse will administer nitrous oxide gas both before and during the whole procedure. For other more painful procedures, such as removing chest tubes or wound care, the ward pediatricians and the pain nurse will prescribe and administer the most suitable form of pain relief.

The Pain Unit, which has professionals in pediatrics, nursing, psychology, anaesthesiology and physiology, was created in 2021 thanks to donations received by SJD Barcelona Children's Hospital.