30 Assessment of a Quality Improvement Pain Management Initiative at a Pediatric Test Centre

Although pain arising from venipuncture can cause children significant distress, it remains under-treated. Safe and cost-effective methods of pain control are readily available; however, healthcare workers’ biases continue to hinder pain management. This study describes the impact of a quality improvement initiative aimed at increasing the provision of validated methods of pain control by phlebotomists to pediatric outpatients at a Canadian tertiary care Centre. A descriptive design was used to assess the Job Aid initiative, which requires phlebotomists to offer all pediatric outpatients (<18 years) developmentally appropriate positions of comfort, distractions, and 4% topical lidocaine prior to venipuncture. Topical lidocaine was applied a minimum of 15-minutes prior to venipuncture. Positions offered to children <1 year included breastfeeding and cradling, whereas older children could sit on their caregiver’s lap, in the phlebotomy chair, or on a stretcher. A light spinner was offered to distract children <1 year and conversation, reading, and blowing bubbles were used in older children. All procedures are documented by a phlebotomist on a Job Aid form, which includes a script for procedure standardization. A secure, online survey system was used to assess the impact of the Job Aid initiative on 65 patients/caregivers and 26 phlebotomists. Patients ranged in age from <1 year to 18 years of age, with 22 patients <1 year of age, 18 patients aged 2–6 years, and 25 patients ≥7 years of age. The patient sample was 57% female (36/63; missing 2 responses). Of participating families, 58.9% selected topical lidocaine. Patients/caregivers reporting lower levels of pain (≤4/10) were more likely to report a higher degree of satisfaction, use of topical lidocaine, seating of child on caregiver’s lap, and venipuncture on first attempt. Lower levels of pain (≤4/10) were reported in the majority of children (59.7%), whereas moderate (5–7/10) and severe pain (≥8/10) was reported in 30.6% and 9.7%, respectively. Of those that provided feedback (n=55), 96.4% indicated the experience was positive. Moreover, the Job Aid initiative improved phlebotomists’ mean job satisfaction from 8.4/10 to 9.0/10. Job satisfaction changed significantly with number of months or years working as a phlebotomist (p = .02). Phlebotomists indicated that topical lidocaine, positions of comfort, and distraction methods were important to implement in pediatrics. Results support existing research indicating both children and healthcare workers benefit from pain control, while providing evidence in support of the Job Aid initiative as a novel framework by which this can be achieved.

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