Introduction Conclusion Acknowledgements Methods ...

Feasibility of Panda, a Smartphone Application Designed to Support Pediatric Postoperative Pain Management at Home Dustin Dunsmuir1-2, Terri Sun1, Matthias Görges1-2, Gregor M Devoy3, Nicholas West1-2, Gillian Lauder1-2, J Mark Ansermino1-2 1Department 2

of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, Canada; Research Institute, BC Children’s Hospital, Vancouver, Canada; 3University of Aberdeen, Aberdeen, Scotland

Introduction •  •  • 

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Following pediatric ambulatory surgeries postoperative care becomes the responsibility of parents and care providers at home [1] A child’s pain is often poorly managed at home [2,3] Poorly managed pain can lead to slower functional recovery, poor oral intake, sleep disturbance, behavioural changes, post-traumatic stress disorder, chronic pain [4] Panda [5] is an app designed to improve pain management at home by assisting parents in

Panda App Setup

Results Pain Assessment

•  Assessing their child’s pain •  Remembering when to give medications •  Tracking medications

Aim: Evaluate the feasibility of parents using the Panda app in a controlled hospital setting, before at-home studies are conducted

Figure 2: Results of the CSUQ showing all median scores were less than Medication Safety Check

Methods With REB approval, and written informed consent, a total of 20 participants have followed the below process in 2 rounds (a 3rd round is in progress): 1. Pre-study questionnaire on child pain management and smartphone familiarity 2. App training with a brief tutorial video 3. App setup by a research assistant •  Demographics •  Medication schedule 4. Parents use the app for 12-24 hours with their child in the hospital •  Nurses give medications according to prescription •  Parents respond to app notifications •  Parents record any off-schedule medication given •  Automatic audit trail in app logs all user actions 5. Post-study data collection •  Respond to Computer System Usability Questionnaire (CSUQ) [6] •  Semi-structured interview for additional feedback Analysis: Between rounds, the audit trail, CSUQ and interview findings were analyzed to inform modifications to app features and design

or equal to 3.5. While the interface was generally easy to use, when problems were encountered it was not obvious how to resolve them

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90/114 (79%) of medication alerts were responded to before next alert •  72 (63%) were responded to within an hour

•  When asked if they would use the Panda app at home: • 

•  14 Yes, 3 No, 1 Maybe, 2 unanswered

Barriers identified: •  Notifications that were not loud or long enough to alert parents •  Confusion surrounding generic drug names •  Difficulties in responding to the app in a hospital setting where nurses were responsible for administering medications

Conclusion CSUQ and interview feedback were positive suggesting that Panda may well be able to support postoperative pain management at home. Useful feedback has informed design improvements, increasing the feasibility of Panda.

Figure 1: Flowcharts of Panda setup and response to an alert

(smartphone notification) including a pain assessment and medication safety checks before giving the scheduled medication Other Panda app features: •  Performing off-schedule pain assessments •  Recording off-schedule medications •  Calendar view shows future schedule medications and past pain assessments and medication activities. A calendar entry can have a note added to it, be redone, or deleted

References [1] Pain Res Manage. 2012; 17(5): 328–34 [2] Pain. 2003; 105(3): 437–43 [3] Pain. 1995; 64: 83–87 [4] Paediatr Anaesth. 2013; 24(3): 239–48 [5] Paediatr Anaesth. 2015; 25(12): 1264-1273 [6] Int J Hum Comput Interact. 1995; 7(1): 57–78

Acknowledgements This research was funded by a Canadian Anesthesiologist’s Society grant (CAS-2016027). We wish to thank all participating families and nurses on the post-surgical ward.