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PainFree Program at CHaD garners a national award

For Joseph Cravero, M.D., medical director of the PainFree Program at the Children's Hospital at Dartmouth (CHaD), teamwork is everything. That's why when the program was honored with a national VHA leadership award—as the best new program in an individual hospital emphasizing safety and patient care— Cravero made sure his whole staff was at the ceremony.

"Everybody has input here in terms of what we do," he says. "Any recognition that we get, we make sure everybody gets it."

CHaD's PainFree Program recently won a national award for dropping its rate of inadequate pediatric sedations to zero.

Sedations: VHA, Inc. (formerly known as the Voluntary Hospital Association), is a cooperative of 2,200 health-care organizations. The group noted the clinical effectiveness of CHaD's PainFree Program, which in its first year—2001-02—cared for over 1,000 patients and reduced the number of sedations judged to be inadequate from 15 percent to zero percent.

Before the PainFree Program existed, about 30 different areas at DHMC were performing pediatric sedations. For many of the health-care professionals, doing sedations was not their primary job responsibility, and 15 percent of the time children were not being sedated sufficiently for their procedures. Under the new program, if kids need sedation, their parents bring them to a centralized location where they meet with the whole PainFree team: a program coordinator, a child-life specialist, a nurse, a patient-care technician, and one or more pediatric anesthesiologists.

Procedures for which children need sedation run the gamut from nuclear medicine scans to bone marrow biopsies to cast removals. The team also works extensively with developmentally delayed children who need immunizations and dental and gynecological exams, which can be difficult for them to receive elsewhere.

"The whole idea here is that we involve the nurses, the pediatricians, and the child-life specialist, and we try to do whatever is required for the kid," says Cravero. This can include general or local anesthesia or sometimes simply a movie or music via headphones. "We really encourage the kids to take the active role. . . . They get to pick how they want to fall asleep," explains Kristin King, CHaD's child-life specialist.

The benefits from the PainFree Program have been considerable. For example, it often took more than half a day to do a 30-minute procedure; now, families can be in and out of the hospital in two to three hours. Kids see the same caregivers each time they visit. And the pediatric staff, says Cravero, "is generally very fun and friendly, so it's just a nicer environment in many ways for parents and kids having something done."

Not only are the patients happier, but productivity has been increased. With more reliable and quicker medications and full-time pediatric anesthesiologists, the program has made it possible to do seven or eight MRIs a day, whereas before the average was four or five a day.

King says kids' and parents' reactions have been remarkable. "We actually had one child who was hanging onto the door jamb trying not to leave, and that is definitely something we did not think we would see," she says. "It's been really fantastic listening to family after family moved to tears, saying, 'We had horrible experiences before and now my child is not afraid of the doctors.' We've had. . . young children writing to say, 'Thank you for making this easy for me.'"

Plan: King assesses each child ahead of time by contacting the family. She then meets with the rest of the PainFree team to develop a specific plan for that child. "It's a very cooperative program," she says. "Everybody has an equal voice."

The program, like its young patients, continues to grow— more than 1,200 were seen in the program's second year.

Matthew C. Wiencke

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