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Abstract
Background Venous access is a common source of pain for hospitalized patients. Topical anesthetics are effective at decreasing needle pain, can improve success rate, and decrease procedure time. At our institution, there is inconsistent use of topical anesthetics for PIV placement.
Objectives The global aim was to reduce pain experienced by hospitalized pediatric patients. The SMART aim was to increase topical anesthetic use for peripheral intravenous line (PIV) placement for hospitalized pediatric patients from a mean of 11% to 40% by June 2019.
Methods The project utilized the Model for Improvement. An institutional clinical pathway and PIV order set were developed. Pre-checked orders for anesthetics were added to order sets. Visual reminders for anesthetic and pathway use were placed on IV carts. Run charts were posted weekly on daily management system boards on each medical-surgical floor, and this data was shared at daily nursing huddles, to increase awareness of performance. Nurse managers provided individual feedback to nurses. Nursing scripting examples of how to discuss PIV placement and anesthetics with patients and families were placed on IV carts.
Results Topical anesthetic use for PIV placement increased from a mean of 11% to 34%. Comfort measures during PIV placement increased from a mean of 6% to 13%. PIV procedures with documentation of placement attempts increased from a mean of 47% to 60%.
Key driver diagram
P-chart. Topical anesthetic use prior to PIV placement from June 2018 to September 2019 increased from a mean of 11% to 34%. A run of eight in a row on the same side of the centerline was used to determine ‘out of control signals’ to shift mean
P-chart. The percentage of PIV placements with the number of attempts documented from July 2018 to September 2019 increased from a mean of 47% to 60%. A run of eight in a row on the same side of the centerline was used to determine ‘out of control signals’ to shift mean
P-chart. The percent of PIV placement procedures that utilized comfort measures from July 2018 to September 2019 increased from 6% to 13%. A run of eight in a row on the same side of the centerline was used to determine ‘out of control signals’ to shift mean.
Conclusions This project has highlighted the importance of pain prevention for needle procedures and initiated culture change. We have nearly reached our goal and PDSA cycles are ongoing to further increase topical anesthetic use.
References
Friedrichsdorf et al. Pain outcomes in a US children’s hospital: a prospective cross sectional survey. Hospital Pediatrics. 2015;5(1):18–26.
Ammentorp J, Mainz J, Sabroe S. Parents’ priorities and satisfaction with acute pediatric care. Arch Pediatr Adolesc Med. 2005;15(2):127–131.
Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics. 2008;122(3):S134–S139.
Ammentorp J, Mainz J, Sabroe S. Parents’ priorities and satisfaction with acute pediatric care. Arch Pediatr Adolesc Med. 2005;15(2):127–131.
Taddio A, Soin HK, Schuh S, Koren G, Scolnik D. Liposomal lidocaine to improve procedural success rates and reduce procedural pain among children: a randomized, controlled trial. CMAJ. 2005;172(13):1691–1695.
Zempsky WT. Optimizing the management of peripheral venous access pain in children: evidence, impact, and implementation. Pediatrics. 2008;122(3):S121–S124. doi:10.1542/peds.2008-1055c
Zempsky WT. Pharmacologic approaches for reducing venous access pain in children. Pediatrics. 2008;122:S140. doi:10.1542/peds.2008-1055g
Leahy S, Kennedy RM, Hesselgrave J, Gurwitch K, Barkey M, Millar TF. On the front lines: lessons learned in implementing multidisciplinary peripheral venous access pain- management programs in pediatric hospitals. Pediatrics. 2008;122(9):S161–S170. doi:10.1542/peds.2008-1055i.
Postier et al. Pain experience in a US children’s hospital: a point prevalence survey undertaken after the implementation of a system-wide protocol to eliminate or decrease pain caused by needles.” Hospital Pediatrics. 2018;8(9):515–523.