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Decreasing Pain in Hospitalized Patients by Increasing Topical Anesthetic Use for Peripheral IVs

Emilee C Lewis1, Stephanie Komkov2, Jenny Rickles2

  • 1From the Division of Pediatric Hospital Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, N.C.

Pediatric Quality & Safety
|August 12, 2024
PubMed

Insights

Topical anesthetic use for pediatric peripheral intravenous line (PIV) placement increased significantly, reducing needle pain. This initiative improved patient comfort and care through enhanced nursing practices and collaboration.

Area of Science:

  • Pediatric Pain Management
  • Evidence-Based Nursing Practice
  • Healthcare Quality Improvement

Background:

  • Venous access procedures, such as peripheral intravenous line (PIV) placement, are a common source of pain for hospitalized patients.
  • Topical anesthetics can effectively reduce needle pain, improve procedure success rates, and decrease procedure time, but their use before PIV placement is inconsistent.
  • A need exists to standardize and increase the utilization of topical anesthetics for pediatric PIV placement to improve patient comfort.

Purpose of the Study:

  • To reduce pain experienced by hospitalized pediatric patients undergoing PIV placement.
  • To increase the utilization of topical anesthetics for PIV placement from a baseline mean of 11% to a target of 40% within a 6-month period.

Main Methods:

  • Implementation of the Model for Improvement framework.
  • Development of an institutional clinical pathway and a PIV order panel with pre-checked orders for topical anesthetics.
  • Utilization of visual aids, nurse feedback, and data sharing through statistical process control charts and daily huddles to promote adherence and awareness.

Main Results:

  • Topical anesthetic use for PIV placement increased from a mean of 11% to 46%, exceeding the target goal.
  • Documentation of comfort measures during PIV placement increased from 6% to 13%.
  • The percentage of PIV placements with an electronic health record order for topical anesthetic rose from 14% to 54%, and documented placement attempts increased from 47% to 70%.

Conclusions:

  • Systemic and cultural changes successfully increased awareness and use of topical anesthetics for pediatric PIV placement.
  • The initiative improved patient-centered care through enhanced collaboration among nurses, providers, and families in venous access planning.
  • Standardized protocols and continuous feedback are effective in improving pain management during common pediatric procedures.
Abstract

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