Enhancing Safe and Pain-less Experiences in the Children's Emergency

Year Submitted: 2025
Published Date: 26 December 2025

Tags: Workflow Redesign, Quality Improvement, Value Based Care, Safe Care, Risk Management, Adverse Outcome Reduction, Care Process ＆ Redesign

About this Content

Aims

Three main issues regarding pain management, including procedural sedations in CE:
Aims are:
a. Halve the proportion of patients crying during procedures using non-pharmacological interventions.
b. Increase sucrose administration to 10.0 per 1000 medication orders.
c. Reduce respiratory adverse events to 4.86 per 1000 sedations.

Background

Pain is a common symptom in children presenting to the Childrens Emergency (CE) with episodic illnesses or acute injuries. Painful procedures such as intravenous cannulations and suturing, are common procedures performed due to medical indications. In CE, we implemented a comprehensive approach to improve pain management and safety. We introduced evidence-based interventions, including age-appropriate non-pharmacological interventions and sucrose analgesia for infants. Procedural sedation is performed for paediatric patients undergoing very painful procedures such as manipulation and reduction of fractures. We enhanced safety in sedation protocols by integrating capnography monitoring. This bundled approach improved analgesic practices and reduced sedation-associated respiratory adverse events.

Methods

Utilised and employed CHAMPS resources which were age-appropriate, accessible via QR codes. Conducted in-service training for doctors and nurses, focusing on evidenced based practices for sucrose administration. Developed workflows and pictorial guides for sucrose ordering and administration, with delineation of specific roles for doctors and assisting nurses. Introduced capnography monitoring for patients receiving ketamine sedation to detect early signs of respiratory depression and intervene before hypoxia occurs. Developed training materials and content covering the-why, the-how and what to do when abnormal ETCO2 readings were trended.

Results

1. Halve the proportion of patients crying during procedures using non-pharmacological interventions: The % of patients crying before and not during the procedure were reduced by half with the different non-pharmacological methods during the pilot and implementation phase. In the post implementation phase, the % of patient crying before procedures with CHAMPS and/ patients preferred videos decreased compared to 2022, indicating that the results are sustainable.

2. Increase sucrose administration to 10.0 per 1000 medication orders: Though the adoption rates of the sucrose administration per 1000 medication orders have improved from 0.0 to 7.6 and 5.6 respectively, there is still room for improvement to reach our target for 10.0.

3. Reduce respiratory adverse events to 4.86 per 1000 sedations: The rate of respiratory adverse events per 1000 sedations dropped by 72.5% from 9.72 to 2.68. As capnography monitoring helped to reduce the variability of the process, distance between incidents was stretched. CE encounters 1 respiratory adverse events every 115 days, as compared to 1 respiratory adverse events every 16.5 days previously.

Conclusion

These outcomes reflect a comprehensive improvement in pain management, patient comfort and safety protocols. The changes demonstrate a successful integration of non-pharmacological interventions, evidenced based practices and advanced monitoring techniques in paediatric procedural sedation.

Lessons Learnt

Inadequate use of non-pharmacological methods for managing anxiety and pain during procedures. A study of 30 patients showed videos significantly reduced crying in children aged 1-10 during painful procedures. No sucrose administration for pain management in infants under one during procedures like IV cannulations and blood draws. Respiratory adverse events during ketamine sedations occurred at 9.72 per 1000 sedations from January 2021 to September 2023.

Keywords

Pain management, Non-pharmacological interventions, Sucrose analgesia, Capnography monitoring

Innovators' Details

Connect with this contributor!

Tham Lai Peng - tham.lai.peng@singhealth.com.sg

Project Attachment

1050_KKH_NHIP_2025_Enhancing_Safe_and_Pain_less_Experiences_in_the_Children_s_Emergency.pdf