Implementation of Virtual Reality for Painful Procedures for Pediatric Emergency Care

Abstract

Problem & Purpose: At an urban Mid-Atlantic teaching hospital, inadequate pain control during procedures was observed to affect a majority of the school-aged patients’ pain in the Pediatric Emergency Department (PED). Uncontrolled pain disrupts healthcare delivery within the PED. Of PED nurses surveyed, half felt added stress with unmanaged pain due to multiple attempts at venipuncture or catheter placement without distraction. Virtual Reality (VR) is an evidenced-based tool with established safety and efficacy in pain mitigation for children undergoing painful procedures. This project aims to impact pain during venipuncture through implementation of VR therapy in eligible patients aged 5-17 years old. Methods: Approximately 33 patients, 53 PED staff members, and 1 Certified Child Life Specialist (CCLS) were involved in the 12-week initiative. To achieve project goals, CCLS and nursing champions facilitated implementation through staff education. Using a VR algorithm, staff screened and offered VR to eligible patients receiving venipuncture and entered data via a Quick Response (QR) code. Chart audits were conducted to monitor the impact of VR utilization on pain and needle procedure success and ensure inclusion of all eligible children. Results: Following implementation, 80% of PED staff were educated on VR. Staff adhered to the VR algorithm 10% of the time. The average VR utilization rate was 25% for eligible patients requiring venipuncture. On a 10-point pain scale, the average pain score was 4.2 for patients where VR was utilized. Conclusion: Findings suggest that VR provided distraction practices for patients during venipuncture, indicating improved pain and quality of care in the PED. Barriers impacting implementation included time constraints, high unit acuity, and gaps in documentation. Although VR utilization remains below goal, limited data supports use of VR to improve care within the PED.