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

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 (., 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 [(143) = 2.50, ≤ 0.05], as well as greater agreement that the pain prevention strategies used helped their children's pain [(180) = 2.17, ≤ 0.05] and that they would be willing to use the same strategy again in the future [(179) = 3.26, ≤ 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 3.10; (70) = -2.11, ≤ 0.05], less agreement that pain from vaccinations is "just part of the process" [3.94 3.23; (70) = 2.61, ≤ 0.05], and less agreement that parents expect their children to experience pain during vaccinations [4.81 4.38; (69) = 2.24, ≤ 0.05]. Parents/caregivers reported more favorable attitudes about pain prevention strategies for vaccinations across a variety of areas, including safety, cost, time, and effectiveness, as well as less concern about the pain their children experience with vaccination [4.08 3.26; (557) = 6.38, ≤ 0.001], less need for additional pain prevention strategies [3.33 2.81; (476) = 4.51, ≤ 0.001], and greater agreement that their doctors' office currently offers pain prevention for vaccinations [3.40 3.75; (433) = -2.39, ≤ 0.05].

CONCLUSION

Quality improvement methodology can be used to help close the gap in implementing pain prevention strategies during routine vaccination procedures for children.