722: POKE PLAN: A QI INITIATIVE TO REDUCE PAIN AND ANXIETY IN PEDIATRIC PATIENTS WITH NEEDLE INSERTIONS

Abstract

Introduction: Adequate control of pain and anxiety during intravenous cannula (IV) placement improves patient satisfaction and reduces medical traumatic stress in children. We aimed to improve the overall experience of needle sticks in children by implementing a year-long multidisciplinary quality improvement project (“The Poke Plan”). Our primary aim was to increase the involvement of child life and use of pediatric pain mitigation strategies by 60% in all hospitalized children. Our secondary aim was to improve patient and parental satisfaction. Methods: A multidisciplinary team was assembled to improve our screening process for difficult IV access in patients on admission and the development of a poke plan pathway. 9 PDSA cycles focused on extensive nursing education, improved documentation, easy access to local pain medication, family involvement and feedback with child life, and weekly updates. Our process measure was the use of poke plan pathway. Balancing measures included increased workload for PIV placement experts. Results: During the study period, 773 patient charts were reviewed (78 pre-intervention [12/20 -04/21] and 695 post-intervention [04/21-07/22]). Compliance with the pain mitigation and distraction strategies increased from 16 – 20% in preintervention phase to > 60% in post implementation phase. The utilization of expert staff increased from 2% to 6%. HCAHPS scores for pain control improved from an average of 73.78% in 2020 to 82.6% in 2021/2022. Process stability of pain mitigation strategies was measured using a control chart. During the first 4 PDSA cycles, there was a significant shift above the center line which was transiently sustained (p=0.001). These cycles included nursing education, ultrasound training, and implementation of a poke plan algorithm. There was then a downward trend back below the center line. Further strategies included weekly huddles and a competition between the units to encourage poke plan usage. Another significant trend upward was observed (p=0.002) following resident education, update of the order sets, and EMR integration. Conclusions: Standardized poke plan pathway including early evaluation, timely team communication, proper preparation and targeted approach can lead to reduction in discomfort with IV access with better patient satisfaction.