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
Sandra Merkel, MS, RN-BC, Clinical Nurse Specialist Acute Pain Service
To view the poster from this project, please click here.