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Improving the Venipuncture Experience in Children with Autism Spectrum Disorder
DeeAnn Hebrink1, Deb Bruene, Cassandra Fowler
1DeeAnn Hebrink is a staff nurse, Deb Bruene is a nursing practice leader, Cassandra Fowler is an evidence-based practice specialist, Kelly Pelzel is a clinical assistant professor, and Kirsten Hanrahan is the director of nursing research and evidence-based practice, all at the University of Iowa Health Care in Iowa City. Contact author: DeeAnn Hebrink, deeann-hebrink@uiowa.edu . The authors have disclosed no potential conflicts of interest, financial or otherwise.
Insights
Implementing individualized care, preparation, and system design significantly improved venipuncture procedures for children with autism spectrum disorder (ASD). This quality improvement project enhanced clinician and parent preparedness, leading to better outcomes for children with ASD.
Area of Science:
- Pediatric healthcare quality improvement
- Autism Spectrum Disorder (ASD) interventions
- Evidence-based practice in healthcare
Background:
- Children with autism spectrum disorder (ASD) often experience heightened fear and distress during healthcare, leading to noncompliance.
- Effective management of needle pain and fear is crucial for children with ASD due to their frequent healthcare needs and limited coping mechanisms.
Purpose of the Study:
- To implement and evaluate evidence-based interventions for improving procedural care and managing challenging behaviors in children with ASD during venipuncture.
- To enhance the venipuncture experience for pediatric patients with ASD.
Main Methods:
- Utilized the Iowa Model for evidence-based practice (EBP) improvement in a pediatric procedure and imaging suite.
- Implemented a practice change encompassing individualized care, patient/family preparation, clinician preparation, and system design based on literature, preferences, and input.
Main Results:
- Clinicians (n=16) showed increased knowledge, comfort, and resource availability, alongside improved workflow utilization and outcomes.
- Parents (n=20) reported improved preparedness, staff comfort, appointment flow, and a more supportive environment.
- Process measures informed improvement opportunities and strategy selection for practice change.
Conclusions:
- Optimizing care for children with ASD during venipuncture involves enhancing individualized care, preparation for patients/families and clinicians, and system design.
- An EBP process model and targeted implementation strategies can facilitate the adoption of interventions to support children with ASD.
Background:
Children with autism spectrum disorder (ASD) may experience heightened fear and distress when accessing health care services, which can result in noncompliance with procedures. Management of needle pain and fear is particularly important for children with ASD given their higher utilization of health care services, neurodiversity, and limited coping skills.
Purpose:
The purpose of this quality improvement project was to implement and evaluate evidence-based interventions to improve procedural care processes and challenging behaviors in children with ASD undergoing venipuncture.
Methods:
The Iowa Model was used to guide evidence-based practice (EBP) improvement in the care of children with ASD undergoing venipuncture at a pediatric procedure and imaging suite of a children's hospital at an academic medical center. Based on evidence from the literature, patient and family preferences, and clinician input, a practice change that included individualized care, patient and family preparation, clinician preparation, and system design was implemented.
Results:
Sixteen clinicians, including RNs, medical assistants, and nursing assistants, demonstrated increased knowledge and comfort in caring for children with ASD, improved availability of resources, improved utilization of procedure support cues and workflows, and improved outcomes. Similarly, 20 parents of children with ASD demonstrated improved preparedness, staff comfort, appointment flow, supportive environment, and awareness of individual needs and communication. Process measures were used to identify opportunities for improvement, select implementation strategies, and design the practice change.
Conclusions:
Improvement in individualized care, patient and family preparation, clinician preparation, and system design can optimize care of children with ASD undergoing venipuncture procedures. An EBP process model and multiple targeted implementation strategies may facilitate the adoption of interventions to support these children.
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