Changing the culture around pediatric pain care

In 2020, the Stollery Children’s Hospital became the Western Canadian hub for Solutions for Kids in Pain (SKIP). SKIP is a national knowledge network whose mission is to improve children’s pain management through education, policy and practice.

One of the goals of SKIP is to bring ChildKind International certification – the highest standards in pediatric pain care – to every hospital that participates in SKIP. For the Stollery, this process began in 2020 with a series of environmental scans of pain care performed by Dr. Elise Kammerer, SKIP knowledge broker and Dr. Samina Ali (pictured, left), Stollery Pediatric Emergency Doctor. In 2021, Jesusa Pulongbarit (picture, centre), Patient Care Manager for Pediatric Trauma and Dr. Samina Ali knew that the next step to getting certified was funding. And that’s when they came to the Stollery Children’s Hospital Foundation with their vision.

Two years after their initial submission, and after overcoming the hurdles of shifting priorities due to the pandemic, they heard back from the Foundation that their project had been approved for funding, thanks to the generosity of donors like you.

The first thing they did was hire a clinical nurse educator: Angela Bokenfohr (pictured, right), who already worked for the Stollery in Pediatric Trauma Surgery and as a front-line leader in pediatric medicine and education. She brought with her intimate knowledge of the gaps in inpatient pain management.

The team of three, along with their SKIP knowledge broker, developed a core working group to achieve their goals. This included medical co-lead, Dr. Hayley Turnbull; Child Life Educator Allison Naylor; the nurse practitioner for Acute Pain Services, Leeann Lukenchuk; two parents of Stollery patients, Dana Nagel and Erica Thomas; and two former Stollery patients themselves, Calveen Basi and Maretta Walker.

“Our Stollery families were front and center,” says Dr. Samina Ali. “They were at the table from the very start to the very end of the certification process. This was for them, with them.”

Achieving certification involved meeting the five ChildKind principles:

• An institutional commitment to pain prevention, assessment and treatment.
• Ongoing education programs and awareness initiatives on pain for staff, trainees, patients and any of their caregivers.
• Use of evidence-informed, developmentally appropriate processes for assessment of acute and chronic pain.
• Specific evidence informed protocols for pain prevention and treatment including pharmacological, psychological and physical methods.
• Regular institutional self-monitoring within the framework of continuous quality improvement.

To achieve these goals, their working group hit the ground running.

• They brought operational leaders onboard, including Christine Westerlund, Senior Operating Officer at the Stollery Children’s Hospital, who presented to Alberta Health Services Edmonton Zone about the certification.
• They introduced an annual pain education day for all Stollery staff, from nurses and lab technicians to security staff and housekeeping.
• They implemented validated pain scales and added pain scale posters at every single bedside.
• They adopted the three Ps for pain – physical, psychological and pharmacological – to ensure pain management was multimodal.
• And they created a pain dashboard that incorporated available pain care data, from Connectcare to patient and family surveys.

“People started to get excited about riding the wave.” says Angela. “I knew my job was making a difference when people started coming to us to learn more about pain management instead of us having go to them.”

Angela still gets goosebumps when she thinks about Alberta Precision Laboratory staff coming to her to learn about pain management in their work with Stollery kids. Phlebotomists (medical practitioners who are trained to draw blood) for the laboratory are not Alberta Health Service employees, but they had heard about the Stollery’s commitment to pain care – and they wanted to be a part of it.

“Pain management is now integrated into the culture of the Hospital more readily than it ever was because of these certification efforts,” comments Dr. Ali, “The heart was always there, but the efforts allowed us to bring it right to the surface and put time and money behind it.”

In January of 2025, the Stollery received their ChildKind International certification, one of only 22 hospitals in the world who have achieved this standard of patient pain management. The Stollery is the first multi-site institution to be certified – all three Stollery sites received certification!

And the team isn’t done there. With the groundwork they’ve accomplished and a dedicated pain committee in place, the future of pain management at the Stollery is bright. What’s more, new technologies and pharmacological advancements are on the horizon: digital technologies, augmented reality, topical anaesthetics that work faster, new non-opioid medications and more. And this is all thanks to donor support.

“But at the heart of it all is the people,” says Jesusa. “Making sure that the people we retain, the people we hire, the people we have at the Stollery continue to recognize that treating pain is a part of our culture. We can always do a little bit more.”