Implementing a Procedural Pain Protocolin Pediatric Patients for Vascular Access Procedures          Texas Children’s Hosp...
Implementing a Procedural Pain Protocol inPediatric Patients for Peripheral IV InsertionsGoal: Reduction in Pain Associate...
The InterventionThe VAT identified 4 agents to trial for procedural painwith Peripheral IV insertions                   in...
The Results      PIVs and Procedural Pain with Placement by the Vascular Access         team350300250200                  ...
Engaging Others• The VAT was instrumental in driving the process   – desire to decrease the number of IV sticks for patien...
Greatest Learnings/Largest Challenges• Learnings  – Understanding the need to be consistent with procedural pain    protoc...
Best Advice• Engage supportive leadership• B open to process changes to d i patient care  Be                   h         d...
Sustaining Change•   Continue to monitor impact.•   Provide annual reports to key stakeholders                            ...
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Procedural Pain Protocol for PIV in Pediatrics

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Implementing a procedural pain protocol in pediatric patients for peripheral IV insertions.

Goal: Reduction in pain associated peripheral IV insertions in pediatric patients. Issue was identified through a hospital initiative for implementation of a procedural pain protocol house wide. The vascular access team (VAT) identified peripheral IV starts as painful procedures that qualified for the initiative.

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Procedural Pain Protocol for PIV in Pediatrics

  1. 1. Implementing a Procedural Pain Protocolin Pediatric Patients for Vascular Access Procedures Texas Children’s Hospital, Houston, TX Theresa Reed, RN, BSN, VA-BC Manager, Vascular Access Team (VAT) VAT performs the majority of IV starts in the facility 350 – 450/month 90% - 100% Ultrasound Use Intervention Timeframe: January 2010 – August 2010
  2. 2. Implementing a Procedural Pain Protocol inPediatric Patients for Peripheral IV InsertionsGoal: Reduction in Pain Associated Peripheral IV Insertions in Pediatric Patients – Issue was identified through a hospital initiative for implementation of a procedural pain protocol house wide. – The Vascular Access Team (VAT) identified Peripheral IV starts as p p painful p procedures that qualified for the initiative.
  3. 3. The InterventionThe VAT identified 4 agents to trial for procedural painwith Peripheral IV insertions insertions. – Developed and implemented a protocol to offer a topical anesthetic agent for each PIV insertion • Vapocoolant Spray • LMX • Sucrose for babies 6 months of age and younger • Buffered Lidocaine for patients >5kg in weight – Documented type of topical anesthetic, number of sticks and success of each PIV insertion conventional insertion technique and ultrasound guided technique from January 2010 through August 2010
  4. 4. The Results PIVs and Procedural Pain with Placement by the Vascular Access    team350300250200 # of PIVs started Ultrasound150 Buffered Lidocaine Sucrose100 50 0 Jan‐10 Feb‐10 Mar‐10 Apr‐10 May‐10 Jun‐10 Jul‐10 Aug‐10
  5. 5. Engaging Others• The VAT was instrumental in driving the process – desire to decrease the number of IV sticks for patients with the use of the ultrasound to visualize veins – decrease the pain associated with PIV insertions in children p – improve patient satisfaction• Materials Management g – Validation of the procedural pain protocol success in conjunction with use of the ultrasound technology provided data to justify cost would be overcome by improved first stick success, reliable venous access and patient satisfaction.
  6. 6. Greatest Learnings/Largest Challenges• Learnings – Understanding the need to be consistent with procedural pain protocol for success in PIV insertion in pediatrics. – Desire to learn new processes such as use of the ultrasound machine for PIV insertion leads to success. s ccess – Staying committed and open to patient care improvement ideas.• Challenges – Convincing administration that the process was worth the cost of the ultrasound machine. – Good data collection is key to supporting change. – Convincing VAT team members procedural pain protocol is worth the time investment reduced pain successful PIV insertions.
  7. 7. Best Advice• Engage supportive leadership• B open to process changes to d i patient care Be h drive i improvements• Listen to and educate the people involved in the change process• Be open to suggestions for change as necessary
  8. 8. Sustaining Change• Continue to monitor impact.• Provide annual reports to key stakeholders stakeholders.• Ensure staff competency is validated.• The Th VAT now has two ultrasound machines and h t lt d hi d requesting a third, 90-100% PIVs now started with ultrasound guidance guidance.

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