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Featured EBP Project - October 2012


The Poke Program: Making Needlesticks and Procedures Less Painful for Children


Team: Needlestick Committee

Sandra Merkel, MS, RN-BC: Acute Pain Service

Catherine Desmet, BSN, RN: Medical/Surgical

Diane Setlock, BSN, RN, CRNI: Vascular Access

Julie Piazza, MS, CCLS: Child Life

Sue Quinn, BSN, RN: Radiology

Harry Neusius, SM(ASCP), MBA: Phlebotomy Services

Deborah Wagner, PharmD: Pharmacy

Deborah Hardenbrook, RN: Cardiac Unit

Mary Watson, MSBA, RN: Ambulatory Care

Paula Garrett, BSN, RN: Medical/Surgical

Michael Lapointe, RN: Hematology/BMT

Shannon Scott-Miller, MA, CCLS, ATR-BC: Child Life

Cindy Straub:  Allied Health Tech, Phlebotomy Services

Kathleen Gibbons, MD: Anesthesiology

Many other “champions”



C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital

University of Michigan Health System

Ann Arbor, MI


Information about the Needlestick EBP Project:

Intravenous insertions, venipuncture, invasive procedures, and immunizations are common sources of pain for children as they receive care, both in the hospital and at their pediatrician’s office.  Pain from these procedures results in short-term suffering and also influences future responses to pain and treatments. Literature indicates that both drugs and non-drug therapies are beneficial in providing comfort.  Feedback from satisfaction surveys indicated that our pediatric hospital had areas for improvement.

A multidisciplinary group was formed to improve pain management, decrease anxiety, and increase satisfaction with needlesticks.  Strategies that would increase comfort for the child and parent were identified in the literature. These strategies included: individualization; honoring choices; distraction; positioning to improve comfort; best words and recognition; parents/caregivers as coaches; drugs; devices; and preparation.  The values and principles of Patient and Family-Centered Care became the foundation of an individualized Poke and Procedure Plan that would include the best strategies identified in the literature. The goal of the plan was to give a voice and choice to the child and to collaborate with the family to provide the best possible experience.  Poke–A–Dot, the comfort dog, became the mascot to help convey to the patient, family, and staff, the message of changing needlestick practices.

The Poke Plan was piloted on a pediatric inpatient medical surgical unit and has been successfully rolled out to other settings (four inpatient units, three ambulatory clinics, one specialty pediatric clinic, and three lab draw areas).  Planning is in process for implementation in the Emergency Department, Preoperative Clinic, Intensive Care Units, and other Pediatric Clinics.

Poke Plan audits are done and completion of Poke Plans on the patient doors have ranged from 43% to 98%.  Patient surveys are also distributed and feedback indicates that the Poke Plan is well received by the families, but staff following the plan does not always happen.  Staff surveys following the initial roll-outs indicated that there were positive effects from the Poke Program with the greatest effect being empowering families, and increasing teamwork and team communication.

Challenges remain in sustaining the changes in practice and in implementing the program in additional pediatric units and clinics.  Orientation, skill development, communication, and collaboration are essential in changing practices.  Sharing patient stories, celebrating successes, and spreading the information about the evidence and data related to giving a child a voice, has helped move the change to other areas.



Team discussing the Poke Plan outside a patient’s door

From left to right;  Andrea Hanley, Child Life;  Cathy Desmet, RN;  Cindy Straub and Reshunda Triplett, Phlebotomists


Contact Person:

Sandra Merkel, MS, RN-BC, Clinical Nurse Specialist Acute Pain Service

Phone 734-763-2435



To view the poster from this project, please click here.