Sharpening Your Skills for Decreasing Needlestick and Procedural Pain and Anxiety: Distraction and Buzzy

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1 Sharpening Your Skills for Decreasing Needlestick and Procedural Pain and Anxiety: Distraction and Buzzy Poke Program Co-leads Julie Piazza CCLS, MS, Child Life Specialist/Project Manager Sandra Merkel MS RN-BC Clinical Nurse Specialist Take Aim at Pain October 23 and 24, 2013

2 Objectives Identify age appropriate distraction techniques to use with needlesticks and procedures Describe how to use Buzzy with needlesticks and procedures

3 Procedures at C.S. Mott Blood draws inpatient (6mos)= 12,600 Blood draws lab (6mos)= 23,400 Surgical Procedures (12 mos) = 15,000 Children s Emergency Services (CES) (12mos) = 25,000+ IV starts and PIC lines Procedures: CT with contrast (6 mos)= 636 Tube insertions: Foleys and NGs Radiological procedures Dressing changes Chest tube removal Immunizations (2009) Venipuncture and IV insertions are the 2 most common sources of pain in hospitalized children

4 Reducing anxiety and pain with procedures-the Evidence Get to know the patient Individualize Honoring choices Preparation Best Words Positioning Distraction Parents as helpers and coaches Positive Recognition Drugs and Devices.

5 Reducing Anxiety/Pain and providing Comfort C.S. Mott Children s Hospital 1. Assess and communicate about pain routinely with families and patients: Collaborative practice guidelines: Spinal fusion surgery, Duramorph analgesia for urological patients, PRC screen, PACU preop call 2. Create an individualized plan with input from the child/parent Poke Program 3. Ask patients and families about pain and comfort 4. Educate patients and families about pain management practices and options 5. Educate staff about how to talk to children & families about pain and its treatment Pain conferences and CE programs 6. Pain order set in MiChart helps guide multimodal approach Managing needlestick pain and anxiety is the most universal way to decrease children s pain. S Leahy

6 Press Ganey June 2013

7 Fear and Anxiety Exacerbates pain Establishes pain experience/memory Increases complications Preparation and information benefit everyone: provide tip sheets and model for parents/caregivers Distraction and deep breathing are effective especially for school age and adolescents (and adults too!)

8 Helping Parents to be Helpful Ask them to help identify pain and anxiety related to needles and immunizations Develop a plan What is working? What is not working? Role play or practice techniques Teach/demonstrate techniques Distraction Deep breathing Touch Comfort Positions Hold Buzzy

9 The Evidence: Distraction Take a stimulus and reframe it Developmentally appropriate Stimulus---engaging Individualize Teach distraction to parents Distraction is used Before During After: speed the recovery/decrease the memory Distraction had a greater effect than EMLA on a child s distress over time. Nurses provided more coaching with distraction than with EMLA. Cohen, LL Pediatrics, 122: 1999

10 Self Help- Activities Activities/Games Peek-a-boo Counting, singing Words of focus and framing the experience Sights and sounds Length of time Provides opportunity for initial steps to development of individual coping skills

11 Self Help-Relaxation Deep-breathing Awareness Practice with the child Blowing bubbles Focusing Visualization In your mind s eye Favorite places, trips, experiences Involvement of the child/teen and/or parent in the activity/stimulus

12 Key messages Case Example Discussions: Distraction 1. Surprise and delight: developmentally appropriate (challenge with teenagers! ) 2. Build on the distraction item to facilitate transitions 3. Overarching stimulus to counter anxiety

13 Tactile Stimulation Stimulate large nerve fibers with pressure is often soothing while intermittent pressure arouses Light steady pressure on painful area Touch sensation competes with pain Between the pain and the brain Opposite side of the pain

14 The Science Behind Buzzy Gate control Vibration and cold shut the gate on the small sensory fibers of sharp pain Alters transduction and transmission Distraction Descending inhibitory control from the brain is triggered to dampen the pain signals

15 Toddlers like to hold it Buzzy Works! Works by cold and vibration Hold in place for 20 seconds prior to injection Available for purchase at the Outpatient Pharmacy

16 Case Examples and Buzzy Practice When to use Buzzy immunizations finger sticks splinter removal cleaning scrapes Tips for using Buzzy strongest vibration at the bottom opposite side

17 Reducing Anxiety and Pain with Procedures Establish a relationship before a procedure Ask about past experiences and what has worked Preparation and use Best Words Make a plan that gives a voice and a choice Include a coach, hold a hand, choose a distraction item Offer/suggest a drug or device Team work and collaboration One voice Communication and Continuity Positive Recognition for what went well