Procedural Pain Management Education

• Comfort Kids RCH Internal Workshops 2023
  This one day face-to-face workshop for RCH staff covers key topics relating to the non-pharmacological and pharmacological support of children undergoing medical procedures.

           Workshop 1: 9 March 2023

           Workshop 2: 22 June 2023

           Workshop 3: 12 October 2023

Please email comfortkids@rch.org.au to register your interest in attending in 2023.

• 'Supporting Children With Procedures' webinar for health care providers will return in 2023. Dates yet to be confirmed. See Eventbrite for details.
  
• Comfort Kids are available to present to your ward or department, please email ComfortKids@rch.org.au to book
  

Guidelines

• Procedural Sedation for Ward and Ambulatory Areas Procedure
• Procedural Pain Management Guidelines
• Acute Pain Management Guideline
• Intranasal fentanyl CPG
  
• Clonidine dosing AMH
  

Education Resources

Learning Packages

• Paediatric Procedural Pain - Education module by PICS EviQ

Presentations

• Principles of Paediatric Procedural Sedation (PDF)
• Procedural Sedation & the EMR (PDF)
• Topical Anaesthesia presentation (PDF)
• Intranasal fentanyl presentation (PDF)
• MAD nasal procedure guide for delivery of intranasal sedation
• Buzzy® Device presentation

Podcasts

• Comfort Kids/Procedural Pain Management - The Education Hub: Conversation with the experts
• Nitrous Oxide and it's use in procedural sedation - The Education Hub - Conversation with the experts
• Patient centred care Part 2 - Involving patients and parents in care - The Education Hub - Think Teach Treat
• Clinical ethics in paediatric nursing: 4 Holding children for clinical procedures necessary or not? - Essential Ethics

Websites

• Society of Paediatric Sedation
  

Positioning Children for Procedures

• Positioning infant fact sheet
• Positioning child fact sheet
  

Adjuncts

• Sucrose Clinical Practice Guideline
• Sucrose Fact Sheet- Be sweet to me baby
• Topical Anaesthesia tip sheet (see Clinical practice Guideline for more information)
  
• Buzzy® Device
  This device may be used in any clinical situation providing the child understands and tolerates the sensation.
  The vibration stimulates the nerves in the surrounding areas, desensitizing the body's awareness of pain.
  Use for: capillary and venous bloods, port access, dressing removal,  IM/SC injections, removal of stitches/staples and dentistry
• Coolsence^TM
  

How to make / find a Procedure Support Plan (PSP)

• Pain / Procedural Support Plan EPIC
  

How to refer to Comfort Kids 

• Comfort Kids Inpatient EPIC Referral
  

How to become competent to administer Nitrous Oxide at RCH

RCH Registered Nurses may become competent to administer nitrous oxide or IV midazolam as outlined by the Comfort Kids Program, Department of Anaesthesia and Pain Management, below:

• To become competent, staff must complete the RCH competencies (theory and skills) and a minimum of three supervised sedation events, independently administering nitrous oxide or IV midazolam
• The competency criterion (theory and skills components) for Procedural Sedation agents must be completed and entered into Learning Hero
• RN's are supervised for the skills component by 1). Comfort Kids Program CNC, 2). After Hours Nurse Lead CNC, 3). CNE/CSN who is competent & confident to train
• Dentists at RCH are credentialed by the Royal College of Dental Surgeons 
• RCH Emergency Department have an internal sedation accreditation program
  
• CNC's from the Department of Anaesthesia and Pain Management, are the only staff at RCH who can determine competency for Medical staff & APN's in ward and ambulatory areas

Nitrous oxide resources

• Nitrous oxide presentation
  
• Nitrous oxide - Orientation and How to guide(Porter MXR Blender and Equipment)
• Nitrous oxide Checklist and Troubleshooting (Porter MXR Blender and Equipment)
• Nitrous oxide Porter MXR user manual (Porter Instrument company PDF)
• Nitrous oxide Competencies theory & skill (2017) 

Nitrous oxide competency process - ONLY for Registered Nurses at RCH

1. RCH Basic Life Support (First-3-minutes) training and competency is required to undertake nitrous oxide competency.
2. Discuss with the NUM and CNE/CSN if competency is appropriate and enroll in Nitrous oxide Learning Hero Module.  
   
3. Complete pre-reading  Procedural Sedation learning guide for health care professionals and  Procedural Sedation 2016 Procedure, use the nitrous oxide competency (theory component) as a guide
4. Complete the nitrous oxide skill competency and post sedation event with a competent CNE/CSN or Comfort Kids CNC, keep this record and enter competency into Learning HERO
   
5. Orientate self to the required documentation including; the EPIC sedation narrator and prescription in MAR          
   
6. Repeat steps 7 & 8 until you have independently administered nitrous oxide a minimum of three times
7. Provide evidence of meeting all of the competency requirements to the NUM and CNE/CSN, enter skills competency into Learning HERO
8. Administer nitrous oxide independently 

For staff credentialed outside of RCH

1. Complete steps 1-6  as per above criteria for the nitrous oxide competency process
2. Independently complete one supervised sedation event with an an accredited CNE/CSN or Comfort Kids CNC
3. Complete the  Procedural Sedation Nitrous Oxide competency - skill, post sedation event, with an appropriate supervisor. 
4. The supervisor and trainee will discuss if further sedation observation is required, if so repeat steps 2 and 3 in this section
5. Provide evidence of meeting all of the competency requirements to the NUM and CNE/CSN, enter into Learning HERO
6. Administer nitrous oxide independently
   

How to become competent to administer IV Midazolam at RCH

IV Midazolam Resources

• IV Midazolam presentation (PDF)
• Comfort Kids Intravenous Midazolam for procedures poster
  
• Procedural Sedation Intravenous Midazolam competency- theory
• Procedural Sedation Intravenous Midazolam competency- skill
  

Midazolam (intravenous) competency process

Intravenous Midazolam competency is currently conducted at RCH on Koala ward ONLY.

• Registered Nurses on Koala ward ONLY may be deemed competent to administer intravenous midazolam at RCH by an accredited CNE/CSN or by a Comfort Kids CNC 
  
• To become competent, Koala ward staff must complete the RCH competencies (theory and skills) and a minimum of three supervised sedation events, independently administering intravenous midazolam 
• The competency criterion (theory and skills) for intravenous midazolam must be completed and entered into Learning HERO
  

ONLY for RNs on Koala ward RCH

1. Basic Life Support is required to become intravenous midazolam competent
   
2. Discuss with the NUM and CNE/CSN if competency is appropriate
   
3. Complete pre-reading  Procedural Sedation learning guide for health care professionals, Procedural Sedation 2016 Procedure, Comfort Kids Intravenous Midazolam for procedures posterusing the Intravenous Midazolam competency - theory as a guide
4. Complete the  Procedural Sedation Intravenous Midazolam competency- theory with a competent CNE/CSN or Comfort Kids CNC, keep this record and enter the theory competency into Learning HERO
   
5. Orientate self to the required documentation including the Record of Sedation,  Comfort Kids Intravenous Midazolam for procedures poster, the EPIC sedation narrator and prescription in MAR 
   
6. Independently complete a supervised sedation event with an appropriate supervisor.         
   
7. Complete the Procedural Sedation Intravenous Midazolam competency- skill, post sedation event, with an appropriate supervisor and document the sedation event 
   
8. Repeat steps 6 & 7 until you have independently administered intravenous midazolam a minimum of three times
   
9. Provide evidence of meeting all of the competency requirements to the NUM and CNE/CSN, enter into Learning HERO and email ComfortKids.Program@rch.org.au
10. Administer intravenous midazolam independently

Quick Tips for Procedural Pain Management: