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Introduction: Evidenced-based tools have long existed to combat pain and anxiety associated with needle sticks, yet the gap between knowledge and uptake persists. Prior to COVID-19, our institution initiated a quality improvement (QI) program to improve comfort measure (CM) uptake, beginning with specific clinical areas with intent to scale up over time. When the COVID-19 vaccine was approved, mass vaccination clinics provided an opportunity to rapidly improve CM uptake across the institution. Methods: Mass vaccination clinics were staffed by nurses from across the hospital. Clinics occurred in 3 waves, based on federal approval for age groups (1: 12y+, 2: 5-11y, and 3: 6m-4y). Each wave was treated as its own PDSA cycle. Families completed a post-vaccination survey to determine what CMs were offered, how much CMs seemed to help their child, and plans for using similar CMs again. Across each wave, data on uptake were considered alongside qualitative feedback from families, nursing staff, and administrative leaders to determine targets for the next PDSA cycle. Selected interventions broadly considered the evidence base across ages, mass vaccination clinic flow, caregiver/patient understanding of available tools, and infrastructure available to support institutional change efforts. Results: Uptake of targeted CMs increased in response to PDSA waves, and generally remained stable thereafter. Across waves, families reported that CMs helped their child with pain/distress (Wave 1: 71%; 2: 88%; 3: 88%) and intended to use some or all the same CMs for future vaccinations (Wave 1: 84%; 2: 96%; 3: 97%); rates increased across both with younger patient age. Conclusions: In a fast-paced mass vaccination clinic, uptake was good to excellent across various CMs and age groups and yielded high satisfaction and interest in future use. Further, many nurses became change agents in their clinical area. Lessons learned will be discussed.




Presented at Society of Pediatric Psychology Annual Conference;. Chicago, Illinois; March 2023.

If We Know Better, Why Don’t We Do Better? A QI Project Aimed at Addressing Pain Related to Vaccinations

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