ASA Abstract Reviews
Feasibility of Panda, a Smartphone Application Designed to Support Pediatric Postoperative Pain Management at Home
Terri Sun, MD
University of British Columbia, Vancouver, British Columbia, Canada
(Summarized and submitted by Terri Sun, MD)
In the last decade, the growing trend towards ambulatory surgery in pediatrics has shifted the burden of a child’s postoperative care onto parents/caregivers at home (Finley et al. 1995; Dorkham et al. 2013). Studies have shown that a child’s pain is often poorly managed at home, and can be attributed to failure to recognize pain, misconceptions about analgesics and inadequate discharge instructions (Dorkham et al. 2013). Poorly controlled acute pain can contribute to slower recovery, poor oral intake, sleep disturbances and behavioral changes and even to the development of post-traumatic stress disorder and chronic pain later on (Sutters & Miaskowski 1997; Power et al. 2012). At British Columbia’s Children’s Hospital, we have developed a smartphone app called Panda, designed to aid parents in assessing postoperative pain and managing analgesic medications at home. The Panda app schedules alerts for pain checks and medication administration. When an alert occurs, the parent and child use the app together to rate the child’s pain and the parent can then give medication following in-app safety checks. All pain scores and medication administration are tracked within the app and can be reviewed later from a calendar.
Usability and feasibility testing of Panda with nurses and parents in hospital demonstrated that the app is “user friendly”. Usability issues were primarily encountered with setup of medication alert/scheduling (33%), editing (16%) and adding (13%) medications. The feasibility study identified that the main barriers to use were unfamiliarity with self-report pain tools, the low audible volume on the app causing missed alerts, and the burden of multi-step pain and medication safety checks. Through iterative improvements, Panda demonstrated good user compliance and positive feedback from surveys/interviews conducted after the study was completed. Although barriers to use still exist such as workflow through the multi-step medication administration, they are currently being addressed in an at-home feasibility study. Smartphone apps are a growing field in health care. Further development of Panda has the potential to improve pain management and communication to improve postoperative outcomes. We are evaluating the potential for Panda to automatically feed back pain and medication data to clinicians to facilitate patient follow-up.
References
- Dorkham, M.C. et al., 2013. Effective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: barriers and possible solutions P.-A. Lonnqvist, ed. Pediatric Anesthesia, 24(3), pp.239–248.
- Finley, G.A. et al., 1995. Parents' management of children's pain following “minor” surgery. Pain, 64, pp.83–87.
- McClellan, C.B. et al., 2009. Use of Handheld Wireless Technology for a Home-based Sickle Cell Pain Management Protocol. Journal of Pediatric Psychology, 34(5), pp.564–573.
- Power, N.M. et al., 2012. Pain and behaviour changes in children following surgery. Archives of disease in childhood, 97(10), pp.879–884.
- Stinson, J.N. et al., 2013. Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer. Journal of Medical Internet Research, 15(3), p.e51.
- Sutters, K.A. & Miaskowski, C., 1997. Inadequate pain management and associated morbidity in children at home after tonsillectomy. Journal of pediatric nursing, 12(3), pp.178–185.
