• Hyperbilirubinemia Algorithm to Decrease Painful Procedures in the Neonatal Intensive Care Unit

      Abramson, Ashley C.; Fitzgerald, Jennifer (2022-05)
      Problem & Purpose: Neonates aged 35 0/7 weeks post-menstrual age (PMA) and greater admitted to a level III neonatal intensive care unit (NICU) suffer from repeated painful procedures daily for the evaluation of hyperbilirubinemia in the first week of life. Transcutaneous bilirubin (TcB) monitoring is a safe and noninvasive alternative that can decrease painful heel lances and provide accurate bilirubin measurements. According to a retrospective chart review conducted for a period from September to December 2020, 66% of eligible neonates cared for in the target NICU experienced painful heel lances for hyperbilirubinemia monitoring despite the availability of TcB monitoring. The purpose of this quality improvement project was to implement and evaluate the use of a hyperbilirubinemia algorithm for infants ≥ 35 0/7 weeks PMA to decrease the number of painful procedures in the NICU. Methods: Project implementation took place over a 15-week period in the Fall of 2021 in a 26-bed level III NICU in a Mid-Atlantic Metropolitan hospital. An interdisciplinary team was created to compose an algorithm and review the use of the bilimeter tool. Data collected pre- and post-implementation included the active ordersets, the use of TcB monitoring and the number of heel lances. Data was collected using electronically run data sets as well as manual chart audits on a weekly basis from the electronic health record. Results: A total of 52 neonates were included in this project. With use of the algorithm, 64% of neonates received TcB monitoring within the first 12-24 hours of life indicating a 55% decrease in the number of heel lances. Conclusions: The use of a hyperbilirubinemia algorithm with TcB monitoring resulted in a reduction of heel lances by more than half, leading to an overall decreased number of painful procedures.
    • Implementation and Evaluation of a Nonpharmacological Device to Improve Satisfaction During Immunization

      Kim, Tamara K.; Satyshur, Rosemarie D. (2021-05)
      Problem & Purpose: Immunization pain is the most common pain experienced by children when visiting their primary healthcare office. In a pediatric primary care office on Maryland’s Eastern Shore, there are inadequate pain relief options used during immunization. Untreated pain can lead to sensitization to future painful experiences leading to greater fear and anxiety, intense distress with future immunizations, needle phobia, and avoidance of healthcare as the individual ages. The purpose of the project was to implement and evaluate the use of the Buzzy device to improve satisfaction during immunization for children aged four to 18 years. The Buzzy device combines vibration and external cold analgesia to control pain at the injection site. Methods: All families with children aged four through 18 years receiving an immunization were educated on and offered use of the Buzzy device. The LPNs assessed the child’s pain score after all administrations and distributed a satisfaction survey to each family when Buzzy was utilized. Data were collected using an implementation log. Data were analyzed using run charts and were presented to the Clinical Site Representative and staff on a monthly basis to elicit feedback. Results: Results indicate that after receiving education on the Buzzy and project goals, 100% of the children and families were willing to try using the Buzzy device to minimize immunization pain and improve satisfaction. Overall satisfaction was scored at 86.3% and among satisfied families, the average pain rating was two out of 10. Conclusions: Data collected indicate that use of the Buzzy device is effective in improving satisfaction during immunization in children and should continue being offered for distraction during immunization. Buzzy sustainability will continue to be driven by family satisfaction with the device during immunization and the device remaining in the practice. Project results will be disseminated through poster presentations.
    • Reducing Pediatric Vaccine-Associated Pain Using The Buzzy

      Hoke, Brittany M.; Connolly, Mary Ellen (2019-05)
      Background: Vaccinations are recognized as a major cause of iatrogenic pain in childhood. Currently no pain management protocol exists at a large suburban pediatric primary care clinic in the mid-Atlantic, for children undergoing vaccination. Local Problem: The purpose of this DNP project was to implement and evaluate the usage of the Buzzy device during vaccination of children ages 4-17 years, at this pediatric primary care clinic. Buzzy is an effective combination of vibration and external cold analgesia, which significantly reduces injection pain in children. The project was designed to improve patient care at this clinic, by addressing the pain management needs of children undergoing vaccination. Interventions: The project took place over the course of 16 weeks. During the first two weeks, the project leader posted Buzzy advertisements throughout the clinic and distributed brochures to families. Nurses (n = 11) and medical assistants (n = 1) were individually trained during this time, regarding proper technique and usage of the device. During weeks 3-16, the nurses and medical assistant utilized Buzzy when vaccinating children ages 4 to 17 years. The project leader collected data using two audit tools: (1) a running log documented by the nurses/MA that tracked the number of patients receiving the Buzzy intervention, and (2) a running log documented by the project leader that randomly tracked those who utilized Buzzy. Staff provided a satisfaction survey to each patient who received Buzzy during vaccination that was submitted anonymously prior to patients leaving the clinic. During weeks 3-16, the project leader reviewed and entered data into an Excel spreadsheet and conducted an analysis of data utilizing descriptive statistics. Data was also analyzed via a run chart to track Buzzy usage and to identify trends over the course of the 14-week period. Results: Staff offered Buzzy to a total of 761 patients. Six hundred and eighteen patients used the device during vaccination, while 143 patients declined. The mean number of patients using Buzzy per week was 43. A total of 523 surveys were completed, yielding an 84.6% survey response rate. Ninety-seven percent of parents and patients surveyed reported satisfaction with their vaccination experience using Buzzy, which well surpassed the project’s goal of 50%. One hundred percent of nurses (5 out of 5) offered Buzzy to patients during audit weeks 3, 5-9, 11 and 14. The satisfaction rate among nurses who utilized Buzzy ranged from 67% during week 4, to 100% during weeks 6-16. Conclusion: The positive response from patients, parents, and staff demonstrates the device’s efficacy and the success of this project, and will aid in its sustainability at this clinic. With continued provider and nursing support, Buzzy has potential to become standard of care during vaccination at this clinic. Implications for future research include use of the device on a younger population of patients, application during additional needle stick procedures, as well as incorporating Buzzy usage into the clinic’s EHR. This project can be utilized as a model for pediatric clinics seeking methods to decrease vaccine-associated pain for their patients.