Background
In medical settings, children are subject to many painful procedures. Pain management during procedures is not only beneficial during the procedure by reducing psychological and physical trauma, but has been shown to impact a child's future response to pain and procedures.
Objective:
To measure the effectiveness of a new educational curriculum in encouraging the use of pain-minimizing techniques during procedures by pediatric residents.
Design/Methods:
A baseline evaluation of 20 procedures on the pediatric floor was obtained. Lectures on procedural pain and pain-minimizing techniques were provided, posters showing different techniques were displayed, pins were created and worn by the residents to raise awareness, reminder group texts were sent, the nursing and phlebotomy staff were involved, and a box with distraction tools was provided.
The acronym "Project SMILE" was created as a reminder of the available procedural pain reduction methods: S= Sucrose drops/breastfeeding for infants; M= maximize distractions; I= Incorporate comfort positioning; L= lidocaine numbing cream; E= Encourage patient/family participation.
Results:
At baseline, distraction was used in 61% of encounters and was seen as successful 64% of the time. Numbing cream was not used. Distress was perceived as mild in 90% of the patients and moderate in 30% by resident observation.
3 months after Project SMILE was initiated, the pediatric residents reported increased usage of methods to minimize procedural pain. The residents were resurveyed at the 1.5-year and 2-year time-points to determine the continued effects of the measures taken during that time period. The majority of residents reported increased use of numbing cream, comfort positioning, distraction measures, and incorporation of patient/family wishes. 40% of residents reported increased use of feeding to minimize pain during procedures. From the 1.5-year to the 2-year time-points, the percentage of residents reporting increased use of numbing cream, distraction measures, feeding, and incorporation of patient/family wishes increased (p-values <0.001 for numbing cream and p<0.01 for the other modalities)
Residents were also asked to report how often they utilized these techniques. After 2 years, there was a significant increase in the number of residents reporting sometimes or always using numbing cream, distraction measures, feeding, and positioning.
Conclusions:
The various measures to minimize procedural pain are well-documented, as are their benefits. However, use of these measures is not always optimized. Our initiative utilized a curriculum with a novel acronym and provided necessary tools for pediatric residents, leading to an increase in the use of methods to decrease procedural pain, which was sustained over time. This initiative can be modified for use in other programs to enhance the use of techniques to reduce procedural pain.
