Compassionate Care R E D U C I N G S T R E S S A N D D I S C O M F O R T D U R I N G N E E D L E P R O C E D U R E S
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1 Compassionate Care R E D U C I N G S T R E S S A N D D I S C O M F O R T D U R I N G N E E D L E P R O C E D U R E S
2 Guided Imagery Being Afraid
3 Understanding Fear and Phobias M o s t c h i l d r e n a r e n e e d l e - a v e r s e a n d e x p e r i e n c e f e a r s u r r o u n d i n g n e e d l e e x p e r i e n c e s. - F i n d i n g w a y s t o m i t i g a t e p a i n a n d d i s t r e s s i s r e g a r d e d a s h i g h l y c l i n i c a l l y r e l e v a n t a n d i n t e g r a l t o t h e d e l i v e r y o f q u a l i t y, p a t i e n t - / f a m i l y - c e n t e r e d h e a l t h c a r e. - N e g a t i v e n e e d l e p r o c e d u r e s c a n h a v e a l i f e - l o n g e f f e c t. - I t i s e s t i m a t e d t h a t u p t o 2 5 % o f a d u l t s h a v e a f e a r o f n e e d l e s w i t h m o s t f e a r s d e v e l o p i n g i n c h i l d h o o d. N e e d l e p h o b i a i s a d e f i n e d m e d i c a l c o n d i t i o n a c c o r d i n g t o t h e D S M 5. - I t i s e s t i m a t e d t o a f f e c t a t l e a s t 1 0 % o f A m e r i c a n a d u l t s. - I t i s c o n s i d e r e d t o b e b o t h a n i n h e r i t e d a n d a l e a r n e d c o n d i t i o n. - I t i s g e n e r a l l y a c q u i r e d b e t w e e n t h e a g e s o f 4-6.
4 Have I convinced you yet? Childhood experiences with immunizations have the potential to effect future health of patients. It can prevent people from going to the doctor, getting routine blood tests and vaccinations or following prescribed treatments. It is a treatable condition. Do you know who to refer to for desensitization?
5 What We are Trying to Avoid
6 What is the message? How do you set the tone? It s okay to have a script. Break into groups of 4-5 and brainstorm a message for children: 4-6 or 7-12 or
7 The Ideal
8 Simple, cost-effective, evidence-based pain-relieving strategies are available. Why don t we use them? What do you lose? What do you gain? What is #1 barrier?
9 Evidenced-Based Recommendations Taddio,et.al FOR INFANTS: -BREASTFEEDING: A c ombined analgesic intervention with skin -tos k in c ontact, holding the c h ild, the sweet -tasting m ilk and the act of s ucking. -SWEET-TASTING SOLUTIONS: Up to 12 m onths of age for infants who cannot be breastfed.
10 P O S I T I O N I N G - T o r e d u c e p a i n a t t h e t i m e o f t h e i n j e c t i o n, D O N O T p l a c e c h i l d r e n i n a s u p i n e p o s i t i o n d u r i n g v a c c i n a t i o n. - I n f a n t s a n d c h i l d r e n s h o u l d b e h e l d b y a p a r e n t i n a p o s i t i o n t h a t i s c o m f o r t a b l e f o r b o t h o f t h e m - I n f a n t s a n d o l d e r c h i l d r e n m a y s i t o n t h e e x a m t a b l e w i t h p a r e n t s t a n d i n g t o p r o v i d e s u p p o r t. - E x c e s s i v e r e s t r a i n t m a y i n c r e a s e t h e c h i l d s s t r e s s s o p a r e n t a n d h e a l t h c a r e p r o v i d e r a r e e n c o u r a g e d t o h o l d a n d s u p p o r t w i t h o u t e x c e s s i v e f o r c e.
11 O R D E R O F I N J E C T I O N S - W h e n a d m i n i s t e r i n g m u l t i p l e i m m u n i z a t i o n i n j e c t i o n s, i n j e c t t h e m o s t p a i n f u l v a c c i n e l a s t t o r e d u c e p a i n a t t h e t i m e o f t h e i n j e c t i o n. M o r e p a i n f u l i m m u n i z a t i o n s i n c l u d e M M R I I, p r e v n a r a n d H P V. T O P I C A L A N E S T H E T I C S - T o r e d u c e p a i n a t t h e t i m e o f t h e i n j e c t i o n, e n c o u r a g e p a r e n t s t o u s e t o p i c a l a n e s t h e t i c s d u r i n g v a c c i n a t i o n. P r e v i o u s s t u d i e s h a v e s h o w n t h a t p a r e n t s a r e w i l l i n g t o a c c o m m o d a t e t h e a d m i n i s t r a t i o n o f t o p i c a l a n e s t h e t i c s i n t o t h e i r s c h e d u l e s, a r e w i l l i n g t o p a y t o r e d u c e t h e v a c c i n a t i o n p a i n a n d a r e a b l e t o a p p l y t h e t o p i c a l a n e s t h e t i c s t o t h e i r c h i l d r e n s s k i n b e f o r e n e e d l e p r o c e d u r e s i f i n s t r u c t e d o n h o w t o d o s o.
12 C L I N I C I A N - L E D D I S T R A C T I O N - D i s t r a c t i o n h a s b e e n s h o w n t o r e d u c e c h i l d r e n s p a i n a n d d i s t r e s s f r o m m e d i c a l p r o c e d u r e s. - D i s t r a c t i o n h a s b e e n d e f i n e d a s t h e u s e o f s t r a t e g i e s t o t a k e a n i n d i v i d u a l s a t t e n t i o n a w a y f r o m t h e p r o c e d u r e. - C a n b e e m p l o y e d f o r c h i l d r e n o f a l l a g e s. - A o n e - t i m e, 1 5 m i n u t e t r a i n i n g p r o g r a m i s a v a i l a b l e o n i n t e r n e t. C H I L D - L E D D I S T R A C T I O N - T o r e d u c e p a i n a t t h e t i m e o f i n j e c t i o n a m o n g c h i l d r e n t h r e e y e a r s o f a g e a n d o l d e r, u s e c h i l d - l e d d i s t r a c t i o n d u r i n g v a c c i n a t i o n.
13 B R E A T H I N G T E C H N I Q U E S - T o r e d u c e p a i n a t t i m e o f i n j e c t i o n, h a v e c h i l d r e n t h r e e years of age and older engage in slow - d e e p b r e a t h i n g o r b l o w i n g d u r i n g v a c c i n a t i o n, - C a n u s e i n e x p e n s i v e i t e m s ( e. g. b u b b l e s, p a r t y b l o w e r s, p i n w h e e l s ).
14 Insufficient Evidence - s w e e t t a s t i n g s o l u t i o n o v e r 1 2 m o n t h s - s k i n - c o o l i n g t e c h n i q u e s ( e. g. v a p o c o o l a n t s p r a y o r c o l d p a c k - s i m u l t a n e o u s i n j e c t i o n s - i n t r a m u s c u l a r v s. s u b c u t a n e o u s l y b e i n g l e s s p a i n f u l - a d m i n i s t r a t i o n o f o r a l a n a l g e s i c s b e f o r e i n j e c t i o n - p a r e n t - l e d d i s t r a c t i o n
15 No-no D O N O T t e l l c h i l d r e n i t w o n t h u r t. I t h a s b e e n s h o w n t o b e i n e f f e c t i v e a n d d e c e p t i v e
16 Goals Provide the W. 38th Street Health Center with the training and tools to minimize the potentially traumatic aspects of care Initiative targets children on the autism spectrum, children with developmental disabilities and children with severe anxiety related to medical care
17 Identifying Target Groups Children with needle phobia: pamphlet for parents and needle protocol Autism group: materials from Hands in Autism as well as a sheet with the details of the visit
18 Needle Protocol for Vaccinations 1. Retrieve Buzzy4shots from designated refrigerator 2. Collect appropriate distraction toys for child use 3. Place child in a comfortable position 4. Allow child to pick out distraction toy. 5. Allow the Buzzy4shots to sit on the area for seconds then move it to a location that is between the source of pain and the nerve pathway to the brain. 6. Swab the injection area with an alcohol pad 7. Administer shot and place Band-Aid on location
19 Needle Protocol for Blood Draw 1. Retrieve ethyl chloride spray and blood draw kit from designated refrigerator 2. Collect appropriate distraction toys for child use 3. Place child in a comfortable position 4. Allow child to pick out distraction toy. 5. Fasten tourniquet at this time 6. Swab the injection area with an alcohol pad 7. Spray the area of blood draw with ethyl chloride for 4-10 seconds or until the skin is white, effective immediately 8. Draw blood and place Band-Aid on location
20 New Equipment Buzzy4shots: Reduces or even helps eliminate the pain that is felt by the shot. How? Uses a cold pack and vibration to numb the pain Must be placed between location of pain and the nerve pathway to the brain Ethyl chloride spray: topical vapo-coolant Distraction toys: Assortment of visual, tactile, and auditory toys All toys along with necessary pamphlets and other information will be placed on a rolling cart. Where can this cart be located? These need to be disinfected after use. Place in the tub marked toys to be cleaned, wipe down with hydrogen peroxide wipes, when clean move to clean drawer.
21 Rolling Cart Buzzy4shots
22 Collection of data Children will be asked for an emotional reading at the beginning and end of medical care Parents will be asked to complete a short-survey with both Likert-scale questions about their experience and their child s experience, and three open-ended questions Data analysis is important in order to judge the effectiveness of the new approach
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31 What Did We Learn? Focus on preventing the development of needle phobia Reduce anticipation time Offer choices: which arm, how fast or slow, want to look or not look, where do you want to be, where do you want your parent to be. Help child develop a plan. Parent and patient education using brochures is helpful. Don t need i-pads with easy access to smart phones.
32 Overall Importance and Benefits Minimizing the trauma associated with medical care Children should not associate going to the clinic with negative experiences or thoughts Healthcare institutions are looking to both provide exceptional care and focus on patient satisfaction Preventative health is key
33 Where do you go from here? What can you take away from this session that you can use in your practice tomorrow? What would you like to know more about?
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AUTISM. Dr.P.SUMITHA HEMAVATHY Medical Director-CAPAAR
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