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Published on: July 13, 2019
Developing a community-based model of care for venipuncture in children and young adults with an intellectual
Pankaj Garg1,2, Larissa Passarello3, Catherine O'Hea2
1University of New South Wales, Sydney, New South Wales, Australia pankaj.garg@health.nsw.gov.au.
Insights
A new care model successfully facilitated blood draws for children and young adults with intellectual/developmental disabilities (ID/DD) and challenging behaviors (CBs). This approach, using reasonable adjustments and sedation, achieved high venipuncture success rates in non-hospital settings.
Area of Science:
- Pediatric Health
- Disability Services
- Medical Procedures
Background:
- Blood tests are crucial for monitoring metabolic side effects but challenging for individuals with intellectual/developmental disabilities (ID/DD) and challenging behaviors (CBs).
- Existing healthcare pathways often fail to accommodate the unique needs of this population for routine venipuncture.
Purpose of the Study:
- To develop and evaluate a specialized model of care to facilitate successful venipuncture in children and young adults with ID/DD and CBs.
- To improve access to essential medical monitoring for a vulnerable patient group.
Main Methods:
- A systematic, tiered model of care was designed, incorporating 'reasonable adjustments' like social stories, distraction, and low sensory strategies.
- Partnership with a community pathology service provider was established.
- An observational retrospective study analyzed demographic data, disability severity, sedation requirements, and venipuncture outcomes.
Main Results:
- 17 venipuncture attempts in 14 children (mean age 12.8 years) at school clinics achieved an 82% success rate using reasonable adjustments and oral sedation.
- In a broader setting, 18 attempts in 16 individuals (mean age 17.3 years) had a 77.7% success rate.
- 31.4% of procedures succeeded with only reasonable adjustments, while 45.7% required conscious oral sedation.
Conclusions:
- A compassionate, non-stressful venipuncture model of care was successfully developed for children and young adults with disabilities.
- The study demonstrates that venipuncture can be performed effectively in non-hospital settings for individuals with ID/DD and CBs considered 'challenging for blood collection'.
Background:
Regular blood tests for monitoring metabolic side effects are often unable to be collected for people with an intellectual/developmental disability (ID/DD) and challenging behaviours (CBs) using usual pathways. We aimed to develop a model of care to facilitate venipuncture for children and young adults with ID/DD and CBs.
Methods:
A systematic tiered model of care was developed for venipuncture to suit the individual needs of children and young adults with ID/DD and CBs. A partnership was formed by the disability health team with a community pathology service provider. An observational retrospective study of the baseline demographic data, severity of disability and diagnosis, oral sedation requirement, and outcome data on the success/failure of venipuncture was done.
Results:
14 children (mean (SD), 12.8 (3.1) years) had 17 attempted venipuncture with 'reasonable adjustments' such as preparation with social stories, distraction, low sensory strategies and oral sedation at school clinics. 14 (82%) attempts were successful. After the success of the pilot programme at school, venipuncture was replicated in settings such as home, day programmes, pathology centres and a respite facility. 16 people with ID/DD and CBs (mean (SD)17.3 (3.7) years), had 14 successful venipuncture performed out of 18 attempts (success rate, 77.7%). Overall, 11 attempts (31.4%) succeeded without requiring oral sedation using only reasonable adjustments. 16 attempts (45.7%) succeeded with conscious oral sedation along with reasonable adjustments. Of those 16, 10 required olanzapine (5 mg), 1 required olanzapine (10 mg), 1 required combination of risperidone (1 mg) and diazepam (5 mg), 1 required clonazepam (2.5 mg) and olanzapine (5 mg), 1 required combination of olanzapine (10 mg) and diazepam (10 mg), 1 required combination of olanzapine (10 mg) and diazepam (5 mg) while 1 required only diazepam (5 mg). One had to be switched to the tier-3 pathway.
Conclusion:
A model of care was developed to ensure compassionate and non-stressful venipuncture for children and young adults with disabilities. We demonstrated that a significant proportion of carefully selected children and young adults with ID/DD and CBs, considered 'challenging for blood collection' can have venipuncture performed successfully in non-hospital settings using 'reasonable adjustments' and oral sedation.
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