Distraction for Vaccine Injection Pain in Pediatrics: Reducing Pain and Enhancing Patient-Centred Care

Abstract

Purpose: The purpose of the DNP project “Distraction for Vaccine Injection Pain in Pediatrics: Reducing Pain and Enhancing Patient-Centered Care” was to investigate the efficacy of distraction to decrease pain in children requiring vaccines improving the quality of health services. This was accomplished by: 1)the development and deployment of an age-appropriate Distraction Toolkit consisting of toys and books for children ages 4-6 years requiring vaccines; 2) Evaluation of pre and post-vaccination pain scores; and 3) Based on Likert scale survey responses results determined if the use of the distraction intervention is something that can be incorporated into daily practice. Background: It is not surprising to find that children have inadequate coping skills to manage pain associated with vaccines. Repeated painful experiences can have lasting negative consequences. Locally, in the clinical setting, there are no guidelines in place to manage injection-related pain. Research on the topic highlights the use of psychological interventions such as distraction being efficacious in managing pain associated with vaccines. Methods: This was a quantitative descriptive study. A pre-intervention educational session was provided to the participating medical assistants about literature that supports the project and the steps involved in the project. Developed based on Ajzen’s Theory of Planned Behavior medical assistants evaluated the usefulness of the kit to determine if it promotes patient-centered care. The process involved: 1) The assistant bringing the kit in prior to the vaccines for the child to explore; 2) While the child is distracted the assistant then brings in and delivers the vaccination; 3) Pain scores using the Face, Legs, Activity, Cry, and Consolability scale, post-vaccine survey, and post-intervention adoption survey were completed by medical assistants to examine perceptions of distraction and its impact on perceived pain and care provided. Outcome: A total of 24 children were included in the project and six medical assistants. Mean post-vaccine pain scores for the group without the intervention was six and three for those with the intervention. Post-vaccine survey questions were generally agreeable with the child being distracted, and vaccine administration being completed successfully. The adoption survey was generally positive regarding the ease of use of the kit, the use of the kit not impacting workflow, and the kit providing patient-centered care. Additionally, the results of the adoptability survey were in general agreeance of implementing this intervention into daily practice. The results were used to create an executive summary to share with the clinical director to facilitate clinical processes. Conclusions: The use of the kit can substantially impact the pain children experience during vaccines. Moreover, it is a simple practice that has little impact on workflow. Future directions include replicating this quality improvement project with a larger sample size. Additional interventions identified in the literature to further the understanding of the impact of the kit include the use of a concurrent pre- and post-vaccine anxiety scale, parents and when appropriate children’s rating of pain and perception of how well the kit worked, and inclusion of different distractors to expand the age range for children requiring vaccines.