Decreasing the ouch! IV start pain management in pediatrics

Abstract

<p><strong>Purpose:</strong> Insertion of pediatric IV&rsquo;s is a procedure that can produce anxiety in patients, families, and healthcare providers. The proper use of procedural pain management in pediatric IV starts can significantly reduce or eliminate the pain associated with the procedure and as a result, decrease anxiety. This evidence-based quality improvement project was implemented to decrease patient pain scores and increase patient and family satisfaction related to IV starts.</p> <p><strong>Design:</strong> This evidence-based project was implemented as a quality improvement project to decrease our patient pain scores and increase our patient and family satisfaction scores related to IV starts in our pediatric population.</p> <p><strong>Setting:</strong> 16 bed pediatric ER that is part of a larger level 1 trauma center.</p> <p><strong>Participants/Subjects:</strong> Patients (age 0-18 years) presenting to the Pediatric ER between August 1 and September 30, 2014 were randomly selected for study inclusion based on the aviailability of the child life specialist who was involved with all participants in the project. All ED nursing staff and child life specialists participated in this project.</p> <p><strong>Methods:</strong> Following IV insertion, the patient&rsquo;s nurse or child life specialist completed a survey regarding pharmacological and nonpharmacological pain management techniques utilized, patient&rsquo;s pain score, and patient and parent&rsquo;s satisfaction with the techniques utilized: Pharmacological Interventions: lidocaine cream (LMX), J-Tip syringe to needlessly administer 1% buffered lidocaine subcutaneously, vapocoolant spray (Pain Ease; Nonpharmacological: comfort positioning, distraction. 30 nurses also completed an online survey regarding their use of, familiarity with, and belief in the various pain management techniques. Upon completion of data collection, all nurses were required to attend a one hour IV Pain Management class led by the unit educator and child life specialist.</p> <p><strong>Results/Outcomes:</strong> For this improvement project we did not have a control group as all patients were offered a pain management option. Of the three options (vapocoolant spray, LMX and J-Tip) the most common methods were vapocoolant spray and J-Tip. Data collected for these methods on patient&rsquo;s pain level along with the patient&rsquo;s and parent&rsquo;s satisfaction were analyzed. On a scale of 0-10 either using the FACES, FLACC or numeric scale the average pain level for insertion was 3.25 with vapocoolant spray and 1.43 with J-Tip. Patient satisfaction on a scale of 0-10 (0 not satisfied and 10 completely satisfied) was 8.44 for vapocoolant spray and 8.58 for J-Tip. Parent satisfaction was 8.87 for vapocoolant spray and 9.61 for J-Tip. The overall average for all IV start pain management methods was a pain level of 2.25, a patient satisfaction of 8.52, and a parent satisfaction of 9.28.</p> <p><strong>Implications:</strong> The use of pharmacological pain management along with nonpharmacological pain management should be a standard for IV starts with any pediatric patient. The use of these methods not only decreases pain but also increases patient and family satisfaction with the procedure. The use of nonpharmacological options allows the parents to be involved, active participants in their child's care. All ER&rsquo;s should offer some form of pharmacological pain management to pediatric patients along with the concurrent use of nonpharmacological pain management such as comfort positioning and distraction.</p>