The pediatric PRO-SELF©: pain control program: an effective educational program for parents caring for children at home following tonsillectomy.

Education of parents in the pediatric ambulatory surgery setting focuses on the provision of information that enables the parent to anticipate events, to understand the meaning and purpose of these events, and to correct misinformation (LeRoy et al., 2003). Standard postoperative care instructions include key points for home care (e.g., diet, activity, incision care, pain management, when to contact the physician for problems, and follow-up appointment). However, the routine information provided on pain management is not adequate given the numerous reports on the undertreatment of postoperative pain in children following outpatient surgery (Gedaly-Duff & Ziebarth, 1994; Hamers & Abu-Saad, 2002; Helgadottir & Wilson, 2004; Homer, Swallow, & Semple, 2001; Huth & Broome, 2007; Sutters & Miaskowski, 1997; Vallee, Lafrenaye, Tetrault, Mayer, & Dorion, 2008; Warnock & Lander, 1998; Wiggins, 2009; Wilson & Helgadottir, 2006). Postoperative pain following outpatient tonsillectomy in children remains a significant problem and optimal use of pain medication is essential to prevent significant postoperative pain (Aguilera & Walker, 1999; Finley, McGrath, Forward, McNeill, & Fitzgerald, 1996; Hamers, Abu-Saad, van den Houten, & Halfens, 1998; Kankkunen, Vehvilainen-Julkunen, Pietila, Kokki, & Halonen, 2003; Nikanne, Kokki, & Tuovinen, 1999) and reduce associated complications including dysphagia, decreased oral intake, and dehydration (Abou-Jaoude et al., 2006; Baugh et al., 2011; Shah, Shahab, Robb, & Roy, 2001; Wiggins & Foster, 2007). Two of the primary reasons for inadequate postoperative pain relief include inadequate prescription and insufficient administration of prescribed medications (Hamers et al., 1998; Kankkunen et al., 2003). As ambulatory programs expand, it is necessary to re-evaluate and explore alternative strategies for delivery of effective analgesia at home, including optimizing the choice of analgesic, the dosing schedule, and parental education to administer analgesics in a more effective manner (Wolf, 1999). With the large increases in the number of outpatient surgical procedures performed in children, parents need to be provided with more comprehensive information and taught the necessary skills to provide effective pain management at home. In this article, we report on one approach that was used as part of two randomized controlled trials (Sutters et al., 2004, 2010) that resulted in increased dosing of scheduled analgesics in children following tonsillectomy. Details and main findings from these two intervention studies are published elsewhere (Sutters et al., 2004, 2005, 2007, 2010). The purpose of this article is 2-fold. First, the article provides a detailed description of the components of the PEDIATRIC PRO-SELF©: Pain Control Program (PPPCP), an extension of the original PRO-SELF©: Pain Control Program (West et al., 2003) for parents and children, which can be used to help parents manage their child’s pain at home following tonsillectomy. Second, the article includes parents’ descriptions of their experiences with the PPPCP that serve to validate the program’s utility in this patient population.