The Wall Street Journal’s Informed Patient column took a close look at “ouchless medicine” techniques practiced at Stony Brook Children’s Hospital.
In a September 28, 2015 post, WSJ chose Stony Brook Children’s as a model among hospitals that are are “taking the hurt out of common medical procedures.” At Stony Brook, clinicians follow pain management protocols to proactively, preemptively, and consistently treat pain in each and every pediatric patient.
Known as the Ouchless Approach to Pediatric Medicine, it’s the cornerstone of treatment for pediatric patients at Stony Brook Children’s, according to Margaret McGovern, MD, PhD, Physician-in-Chief. Designed to specifically address acute pain, the approach acknowledges that many children arrive in pediatric emergency departments in different levels of pain, following an injury or because of an illness, etc. And clinicians often have to give injections, reset broken bones, and do other procedures may result in pain or discomfort in patients.
As an academic teaching hospital,Stony Brook Children’s trains medical students and residents to take a few moments to think about how to manage pain before a procedure.
“It doesn’t take much time and few situations require immediate action before pain medication can be given,” says Sergey Kunkov, MD, MS, MBA Director of the Pediatric Emergency Department. “Even if a procedure is expected to last just a few seconds, something could happen and the procedure could last longer than anticipated, or it could be remembered by a patient as some of the worst few seconds of their life. Simple, effective treatments are readily available to mitigate pain, so even minimal pain during a procedure is just not necessary.”
The Ouchless Approach at Stony Brook Children’s starts in the pediatric emergency department’s triage unit. “If a child is expected to need an IV, a triage nurse will apply a numbing cream where the IV is likely to be placed. If a child comes in with an obvious injury, such as a broken leg, pain medicine, such as short-acting analgesic intranasal spray, or calming medication for anxiety, is given in triage,” says Dr. Kunkov.
Clinicians follow the same basic safety principles used before any medication is given — first asking about known allergies, and any medications the child is current taking. “It takes less than a minute to assess risks of pain management; and most patients are unlikely to be allergic to pain medications, or to have a contraindication,” says Dr. Kunkov.
The Stony Brook Children’s team of Child Life Specialists — full-time staff trained to make children’s experiences more comfortable and less stressful — are another vital component of the Ouchless Approach. Child Life team members work to engage and distract pediatric patients, which in turn reduces their parents’ anxiety, which is very important since children often mimic or react strongly to feelings displayed by their parents.
“Therapeutic interventions are just part of our Ouchless program,” says Dr. Kunkov. “To this day, I don’t know what works better, pain medication or good distraction. I think it’s often equal, and combined even better. Once a child’s mind is off the treatment, a procedure or treatment often proceeds much more smoothly than it may have otherwise.”
The Child Life team also teaches clinicians how to use simple distraction techniques to ease a child’s or a parent’s anxiety. Distractions range from simple things, such as video games on iPads, to starting an exam by talking to the child’s doll, looking for doll’s boo-boo, giving it ‘treatment’, etc.
“I’ve learned a lot from our Child Life team, particularly how to phrase something so it’s less scary to a child. For example, instead of talking about stitches, to instead say that we have ‘new super cool shoelaces for your cut – but we only have black or blue, which do you choose?’” says Dr. Kunkov.
If a hospital or clinician doesn’t raise the subject of acute pain management, Dr. Kunkov encourages parents to ask about it. “I’ve brought my own child to the Stony Brook Children’s pediatric emergency department, and being able to to experience our Ouchless Approach as a parent made its benefits even clearer to me than they were before.”