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Development and implementation of a transcutaneous electrical nerve stimulation protocol for pediatric overactive
Monika A Gasiorek1, Kathleen Kieran1, Paul A Merguerian1
1Division of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States of America.
Introduction And Objectives:
Transcutaneous electrical nerve stimulation (TENS) is an established therapy for overactive bladder (OAB) that had not previously been offered in our pediatric urology clinic. We implemented TENS as an alternative second-line option for OAB refractory to standard urotherapy. Our objective was to develop a standardized protocol for TENS prescription and to increase advanced practice provider (APP) understanding and confidence with prescribing this therapy.
Methods:
Our quality improvement initiative was designed, conducted, and reported in accordance with the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines. It consisted of two Plan-Do-Study-Act cycles: (1) protocol and resource development with small-scale testing involving two nurses and two APPs under physician oversight, and (2) broader protocol implementation through structured APP training. The primary outcome measures were APP understanding and confidence with prescribing TENS therapy, assessed via a survey administered before, immediately after, and 3 months following training. Our process measure was the number of TENS prescriptions following protocol implementation.
Results:
We developed a standardized protocol for TENS therapy in patients with OAB refractory to urotherapy, outlining inclusion and exclusion criteria, device specifications and settings, a multi-step evaluation schedule, and patient and provider resources. The protocol was implemented across seven clinical sites through an APP training webinar. Prior to implementation, 50% (5/10) of APPs were familiar with TENS as a treatment option for OAB, 10% (1/10) felt confident prescribing it, and 0% (0/10) felt confident managing it. Following implementation and at 3 months, 100% (10/10) of APPs reported understanding and confidence with prescribing TENS, and by 3 months, 100% (10/10) reported confidence with managing the therapy. Over the subsequent 5 months, 11 patients were initiated on TENS.
Conclusions:
We successfully developed and implemented a standardized TENS protocol, leading to increased APP understanding and confidence in prescribing this therapy for patients with refractory OAB across multiple clinical sites.