Using quality improvement methods to increase use of pain prevention strategies for childhood vaccination

• 作者: Amanda D Deacy Dustin Wallace Jennifer Verrill Schurman Jolynn Parker Kevin Mroczka Kristi Williams Lynn Anson Mark Connelly Rebecca J Johnson
• 来源期刊: 世界临床儿科杂志
• 学科: 医学
• 关键词: PEDIATRICS Quality improvement DISTRACTION PAIN management Immunization VACCINATION SUCROSE analgesia PAIN prevention Non-nutritive SUCKING Comfort positioning Primary care
• 年，卷（期）: 2017,（1）
• 页码范围: 81-88
• 页数: 8页
• 分类号: R

摘要

AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.METHODS 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.RESULTS 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,co