MacDougall Terri, Cunningham Shawna, Whitney Leeann, Sawhney Monakshi
North Bay Nurse Practitioner-Led Clinic, North Bay, Canada.
Health Quality Ontario, Toronto, Canada.
Int J Health Care Qual Assur. 2019 Jul 8;32(6):1034-1040. doi: 10.1108/IJHCQA-07-2018-0185.
The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC).
DESIGN/METHODOLOGY/APPROACH: The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project.
Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form.
RESEARCH LIMITATIONS/IMPLICATIONS: This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide.
Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice.
ORIGINALITY/VALUE: This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.
本文旨在分享从一项质量改进（QI）项目中吸取的经验教训，该项目在将额外的循证疼痛缓解策略应用于实践后，对儿科疼痛评估分数进行了研究。大多数护士会承认，他们在注射过程中会采取一些措施来减轻疼痛。在疫苗接种过程中解决疼痛问题对于预防针头恐惧、疫苗犹豫和医疗回避至关重要。该项目的目的是降低疼痛程度，这一点在北湾护士执业医师主导诊所（NBNPLC）的疫苗接种时的疼痛评分中得到体现。
设计/方法/途径：本研究的设计为准实验性研究，采用描述性统计和QI工具。NBNPLC利用改进模型来测试变革想法。使用一种经过验证的观察工具（修订后的面部、腿部、活动、哭泣和安抚性量表）来评估儿科人群疫苗接种过程中的疼痛，以测试变化情况。该团队根据最佳实践指南精心策划改进措施，以优化注射过程中减轻疼痛策略的使用。利用QI工具和领导技能来改善疫苗接种过程中儿科的疼痛体验。家长和临床医生为该项目提供了定性和定量反馈。
护士们测试了疼痛评估工具，并同意使用经过验证的工具来评估疫苗接种过程中的疼痛。家长们同意在疫苗接种过程中使用局部麻醉剂。使用局部麻醉剂后，疫苗接种过程中的疼痛评分有所改善。家长们同意在疫苗接种过程中使用标准化蔗糖溶液。使用标准化蔗糖水后，疼痛评分降低。为了维持该指南的实施，设计了一份护理记录表格，护士们同意持续使用该表格。
研究局限性/启示：这是一个QI项目，研究了将临床实践指南转化为临床实践的复杂性。该项目验证了疫苗接种过程中疼痛管理的指南。希望改善疫苗接种过程中儿科疼痛的诊所领导会发现本文作为指南很有帮助。
将在家长对疼痛的期望背景下探讨儿科人群的疼痛管理。将概述QI工具、吸取的经验教训以及对护士的建议。领导在将实践指南转化为实践中发挥着有影响力的作用。
原创性/价值：本文概述了组织支持如何有助于让临床医生有时间刻意挑战实践，以提高疫苗接种期间儿童的护理质量。
