CHEO Assessment & Management of Pain (CHAMP): A Quality Improvement Project

The goals of this 4-phase project are to; i) establish baseline data regarding pain management practices for hospitalized children at CHEO; ii) identify unit-specific areas of improvement regarding pain management practices; iii) develop unit specific quality improvement plans; and iv) re-evaluate pain management practices to assess effectiveness of the unit-based quality improvement interventions. Pre-and post-intervention pain audits will occur on inpatient units on a single day for the two study periods, and will include patient record chart audits from the previous 24 hours and patient/parent surveys. Data collected will include the type and effectiveness of pain treatment used, documentation of treatment and pain assessment, and the prevalence and severity of pain. We completed the baseline audit/survey for this study on April 11, 2018 and a repeat audit/survey occurred on November 6 & &, 2018.  

Approximate start and end date: January 2018 – December 2019
Investigators: Denise Harrison (PI), Brenda Martelli (CoPI), Gail Macartney, Jessica Reszel
Funding source: CHEO Quality Improvement Grant
Contact information: Jodi Wilding, Research Coordinator
Participants: 51 patients participated in phase I baseline survey; Staff from 6 CHEO inpatient units will participate in phases II and III; 51 patients participated in phase IV repeat survey.
Status: Currently analyzing results and preparing publications.

FLACC Training Tool Development: Pilot evaluation of a pain assessment training tool for health professionals and researchers

The FLACC is one of the recommended pain assessment tools used at CHEO and in many other pediatric hospital settings. However, there is currently no training tool that has been developed to provide instruction to clinicians or researchers regarding use of the FLACC scale. In order to address the need for training on the use of pediatric pain tools our research team is conducting a 3-phase pilot study to develop and test a FLACC training tool in both English and French. The objectives of this 3–phase pilot project are to: i) identify features of effective and user-friendly training tools for clinicians and researchers and develop a FLACC training tool; ii) evaluate the usability of the FLACC training tool developed in phase 1 and make subsequent improvements; iii) evaluate the efficacy of the revised version of the FLACC training tool in improving scoring accuracy and user confidence with both pediatric nurses at CHEO and nursing students in the English and French programs at the University of Ottawa.

Approximate start and end date: May 2017 – April 2019
Investigators: Denise Harrison (PI), Brenda Martelli, Julie Chartrand, Juliana Choueiry
Funding source: CHEO Research Institute Summer Studentship Award; University of Ottawa Teaching and Learning Support Service; Consortium national de formation en santé (CNFS).
Participants: 8 health care providers participated in phase I; 8 health care providers participated in phase II; 34 nurses and 67 undergraduate nursing students participated in phase III.
Contact information: Jodi Wilding, Research Coordinator
Status: Currently analyzing results and preparing publications.

Validating Skin Conductance for Assessing Pain and Stress in Mechanically Ventilated Infants

The purpose of this study is to evaluate the use of skin conductance for assessing pain and stress in mechanically ventilated babies who are admitted to the NICU at CHEO. In this study, we are hoping to find out if skin conductance is an accurate way to measure pain during painful and non-painful procedures that babies need as part of their care.

Approximate start and end date: October 2017 – June 2019 
Investigators: Jiale Hu (PI), Denise Harrison, JoAnn Harrold, Janet Squires 
Funding source: Ontario Trillium Scholarship; Sigma Theta Tau International/Rosemary Berkel Crisp Research Award; Canadian Pain Society. 
Contact information: Jiale Hu
Participants: 55 patients were enrolled at CHEO
Status: Currently analyzing results and preparing publications.

Be Sweet to Babies during Immunizations—Showing the Evidence

We have produced a new and revised video showing the analgesic effects of breastfeeding and sucrose during infant immunizations. This video was posted on YouTube for widespread dissemination. To maximize accessibility, we produced the video in multiple languages including English, French, Portuguese, Parsi, Spanish, Mandarin, Arabic, Inuktitut, Hindi, and Vietnamese.

We are continuing to translate these videos into additional languages and disseminating them via social media. We will evaluate the reach of these videos over time.

Click HERE to see the videos.

Approximate start and end date: July 2015 – December 2019.
Investigators: Denise Harrison (PI), Lucia Figueredo, Alyssa Nader, Catherine Pound, Jessica Reszel, Margaret Sampson,Samantha Somers, Anna Taddio 
Funding source: CIHR
Contact information: Jessica Reszel, Research Coordinator
Status: Currently disseminating results

Sucrose Practices for Pain in Neonates (SPiN): Part B

This is a multi-site, multi-phase study led by Dr Bonnie Stevens (SickKids and University of Toronto). Recently, we completed the first part of the study (SPiN Part A: Determining the Minimally Effective Dose of Sucrose for Procedural Pain in Infants) which determined that the lowest amount of sucrose needed to manage babies’ pain is 0.1 mL. See the results of SPiN Part A HERE.

Part B of this program of research has 2 studies: 
Study 1 (Efficacy of Repeated Sucrose Administration, Infant Response to Administration, and Effect on Outcomes) will examine the effect of repeated administration of the minimally effective dose of sucrose (0.1 ml) on immediate (pain intensity) and long-term (neurodevelopmental) outcomes in babies born at <32 weeks gestational age and hospitalized in neonatal intensive care units (NICUs).

Study 2 (Influence of Practice Context Factors on Sucrose Administration Practices) will use a staff survey to explore the influence of contextual factors on nurses’ sucrose administration practices in NICU.

This study is recruiting preterm babies (<32 weeks) during the first 10 days of life as well as nurses in NICUs at CHEO and The Ottawa Hospital General Campus. Currently, we have enrolled over 40 babies and anticipate that recruitment will be completed shortly. We will then continue to follow these babies for at least 18 months to assess neurodevelopmental outcomes. We also recruited about 40% of our NICU nursing staff to complete our survey and we are now analyzing the results.

Approximate start and end date: July 2016 – December 2019
Ottawa site investigators: Denise Harrison and Thierry Daboval
Funding source: CIHR
Contact information: Jodi Wilding, Research Coordinator
Participants: 52 patients were enrolled at CHEO and TOH
Status: Recruitment closed; enrolled patients currently being followed for 18 months. 

 

Be Sweet to Toddlers during needles: RCT of sucrose compared to placebo

This study aims to determine whether giving toddlers (ages 12 to 36 months) 24% sucrose by mouth is effective in reducing their pain during venipuncture, compared to water. This study is recruiting patients from the medical and surgical units at CHEO (4E, 4W, 5E, Medical Day Unit). Currently we have enrolled 57 toddlers with the goal to enroll a total of 140.

Approximate start and end date: November 2015 – December 2019
Investigators: Denise Harrison (PI), Nick Barrowman, Sandra Dragic, Brenda Martelli, Regis Vaillancourt, Helen Yoxon
Funding source: Internal funding
Contact information: Jodi Wilding, Research Coordinator
Participants: 140 patients will be enrolled at CHEO
Status: Recruitment open 

Caring for Babies: A Study of Ontario Maternal-Newborn Hospitals on the Effectiveness of Parent-targeted Education (ONesiE)

This provincial cluster randomized controlled trial (RCT) seeks to determine if a parent-targeted video intervention delivered at the organizational level results in improved use of pain treatment (breastfeeding, skin-to-skin care, or sweet solutions) for newborn babies during the newborn screening blood test. We are currently inviting eligible hospitals providing maternal-newborn care in Ontario to participate in this study.

Approximate start and end date: October 2016 – September 2019
Investigators: Denise Harrison (PI), Sandra Dunn (CoPI), Marsha Campbell-Yeo, Lucy Gilmore, Ian Graham, Jeremy Grimshaw, JoAnn Harrold, Jiale Hu, Catherine Larocque, Leanne McArthur, Becky Nicholls, Stuart Nicholls, Pat O'Flaherty, Shahirose Premji, Jessica Reszel, Sonia Semenic, Janet Squires, Bonnie Stevens, Monica Taljaard, Marie-Josée Trépanier, Kathy Venter, Yiyan Zhou
Funding source: Ontario Child Health SUPPORT Unit (OCHSU) - IMPACT Child Health Award
Contact information: Jodi Wilding, Research Coordinator
Participants: Up to 20 Ontario maternal-newborn hospitals will be enrolled
Status: Recruitment open