Background and aims: 
Quantifying the complete process of pain assessment and treatment would contribute to develop strategies to provide safer care, but has proven difficult to achieve. We illustrate the usability of a comprehensive electronic health record to quantify among hospitalized children pain assessment, reassessment, and pharmacological treatment of pain, and to describe variation across healthcare providers and explore organizational determinants associated with time to reassessment and pharmacological treatment.
Methods:
 Retrospective observational study of 11 949 child stays on three hospitalization wards in a tertiary care center in 2016 and 2017. Depending on the child’s age, pain was assessed using the comfort behavior scale, faces pain scale-revised or a numeric rating scale. We linked administrative data, a state-of-the-art electronic health record care module detailing planned and unplanned care, computerized physician order entries and electronic medication administration records with barcode medication administration, and nurse personnel records.
Results: 
Pain occurred in 33.7% of stays. Among 3 315 399 care activities, pain assessment was the most frequent planned (6.0%) and third most frequent unplanned (8.8%) activity. Median time to reassessment was 3.4h, which ranged from 0.9h to 7.9h across the 125 pediatric nurses. Reassessment within 1-2h in case of oral pain medication and within 15-30min in case of parenteral medication occurred in 11.9% and 2.4% of cases, respectively. Evening and night shifts and first day postoperatively showed shorter time to reassessment.
Conclusions:  
A comprehensive electronic health record provides revelatory and actionable insights. Increased attention to timely pain reassessment and pharmacological treatment is warranted.

EVALUATION OF PAIN ASSESSMENT, REASSESSMENT AND PHARMACOLOGICAL TREATMENT IN HOSPITALIZED CHILDREN THROUGH AN ELECTRONIC HEALTH RECORD LINKING CARE ACTIVITIES WITH MEDICATION ORDERING AND ADMINISTRATION