Published online Feb 8, 2017. doi: 10.5409/wjcp.v6.i1.81
Peer-review started: July 16, 2016
First decision: August 4, 2016
Revised: October 20, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: February 8, 2017
To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.
Specific intervention strategies (i.e., comfort positioning, nonnutritive sucking and sucrose analgesia, distraction) were identified, selected and introduced in three waves, using a Plan-Do-Study-Act framework. System-wide change was measured from baseline to post-intervention by: (1) percent of vaccination visits during which an evidence-based pain prevention strategy was reported as being used; and (2) caregiver satisfaction ratings following the visit. Additionally, self-reported staff and caregiver attitudes and beliefs about pain prevention were measured at baseline and 1-year post-intervention to assess for possible long-term cultural shifts.
Significant improvements were noted post-intervention. Use of at least one pain prevention strategy was documented at 99% of patient visits and 94% of caregivers were satisfied or very satisfied with the pain prevention care received. Parents/caregivers reported greater satisfaction with the specific pain prevention strategy used [t(143) = 2.50, P≤ 0.05], as well as greater agreement that the pain prevention strategies used helped their children’s pain [t(180) = 2.17, P≤ 0.05] and that they would be willing to use the same strategy again in the future [t(179) = 3.26, P≤ 0.001] as compared to baseline. Staff and caregivers also demonstrated a shift in attitudes from baseline to 1-year post-intervention. Specifically, staff reported greater agreement that the pain felt from vaccinations can result in harmful effects [2.47 vs 3.10; t(70) = -2.11, P≤ 0.05], less agreement that pain from vaccinations is “just part of the process” [3.94 vs 3.23; t(70) = 2.61, P≤ 0.05], and less agreement that parents expect their children to experience pain during vaccinations [4.81 vs 4.38; t(69) = 2.24, P≤ 0.05]. Parents/caregivers reported more favorable attitudes about pain prevention strategies for vaccinations across a variety of areas, including safety, cost, time, and effectiveness, as well as less concern about the pain their children experience with vaccination [4.08 vs 3.26; t(557) = 6.38, P≤ 0.001], less need for additional pain prevention strategies [3.33 vs 2.81; t(476) = 4.51, P≤ 0.001], and greater agreement that their doctors’ office currently offers pain prevention for vaccinations [3.40 vs 3.75; t(433) = -2.39, P≤ 0.05].
Quality improvement methodology can be used to help close the gap in implementing pain prevention strategies during routine vaccination procedures for children.
Core tip: Application of quality improvement methodology can help close the gap in implementing evidence-based pain prevention strategies during routine medical procedures, such as childhood vaccination. A key element to the adoption and maintenance of practice change appears to be building a meaningful partnership with key staff (e.g., nurses who routinely deliver vaccinations) within the target clinic to elicit their expertise and input, as well as facilitate their ownership of the process. Development of project “champions” among key staff can help reduce barriers to implementation, increase uptake of practice change, and shift culture to support long-term maintenance of gains.