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Organisation des Schmerzmanagements bei Kindern

Österreichische interdisziplinäre Handlungsempfehlungen zum perioperativen Schmerzmanagement bei Kindern

Organization of pediatric pain management

Austrian interdisciplinary recommendations for pediatric perioperative pain management

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Zusammenfassung

Hintergrund

Das postoperative Schmerzmanagement ist nach wie vor stark verbesserungsfähig, für Kinder gilt dies in besonderem Maße. Ziel dieses Artikels ist es, aufzuzeigen, welche Strukturen und Abläufe zu optimieren sind, um letztlich die Zufriedenheit und Sicherheit der Patienten zu verbessern.

Verantwortlichkeiten

Grundvoraussetzungen sind u. a. personelle Kontinuität sowie eine gute Kooperation im multiprofessionellen Team. Auch eine klare Zuordnung von Zuständigkeiten ist von wesentlicher Bedeutung.

Anamnese und Aufklärung

Bei der Aufnahme sollte jeder Patient nach aktuell bestehenden Schmerzen befragt werden. Die Patienten bzw. ihre Eltern müssen auf verständliche Weise über die Schmerztherapie informiert werden. Anzusprechen sind mögliche Komplikationen, Erfolgsaussichten, Vor- und Nachteile der geplanten Maßnahmen und Behandlungsalternativen.

Umsetzung

Die Umsetzung benötigt viel Aufmerksamkeit. Die Einführung klar definierter Abläufe und gründliche Schulungen tragen entschieden mehr zu einem erfolgreichen Schmerzmanagement bei als die alleinige Etablierung einer Schmerzmessung oder die Einführung spezieller Techniken.

Erfassung und Dokumentation

Da die Schmerzintensität nur indirekt beschrieben werden kann, ist ihre Erfassung bei Kindern schwierig. Bis zum Ende des vierten Lebensjahrs erfolgt eine Fremdbeurteilung. Goldstandard der Schmerzmessung ist aber die Selbsteinschätzung mit entsprechenden Skalen. Sie ist bei älteren Kindern möglich. Für die Kontrolle und Optimierung der Schmerztherapie sind die routinemäßige Aufzeichnung der Schmerzwerte sowie die zeitnahe Dokumentation aller schmerztherapeutischen Maßnahmen unerlässlich.

Ergebnisqualität

Ob tatsächlich eine Verbesserung der Akutschmerztherapie bei Kindern erreicht wurde, lässt sich nur durch eine standardisierte Erhebung und Analyse der Therapiequalität erfassen. Zu diesem Zweck wurde QUIPSInfant entwickelt.

Abstract

Background

Postoperative pain management is still in need of vast improvement, especially for children. The aim of this article is to demonstrate which structures and processes must be optimized to ultimately improve patient satisfaction and safety.

Responsibilities

Basic prerequisites are among others personnel continuity and good cooperation in a multiprofessional team. A clear assignment of responsibilities is also of essential importance.

Patient history and informed consent

On admission every patient should be questioned on the currently existing pain. Patients or the parents must be informed about the pain therapy in a comprehensible manner. Possible complications, chances of success, advantages and disadvantages of the planned procedure and alternative forms of treatment must be discussed.

Implementation

The implementation needs a great deal of consideration. The introduction of clearly defined pathways and thorough schooling contribute more to successful pain management than the establishment of pain measurement or the use of special techniques alone.

Evaluation and documentation

Because pain intensity can only be described indirectly it is difficult to assess in children. Assessment is made by another person until children are 5 years old. The gold standard in pain measurement is, however, self-estimation using appropriate scales which is possible for older children. The routinely carried out representation of pain values and prompt documentation of all pain therapeutic measures are indispensible for the control and optimization of pain therapy.

Quality of results

Whether improvements in acute pediatric pain therapy will actually be achieved can only be realized by standardized compilation and analysis of the quality of therapy. For this purpose QUIPSInfant was developed.

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Interessenkonflikt. A. Sandner-Kiesling: Vortrags- und Beratungstätigkeit für Fresenius Kabi, Mundipharma, Grünenthal und TEVA. B. Messerer gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Messerer, B., Sandner-Kiesling, A. Organisation des Schmerzmanagements bei Kindern. Schmerz 28, 14–24 (2014). https://doi.org/10.1007/s00482-013-1383-1

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