P0123 - Decreasing pain experienced by patients 0-6 months of age during minor procedural pain in the YNHCH Pediatric Emergency Department by increasing the use of oral sucrose

Goal: To increase oral sucrose use for pain management for common invasive procedures (PIV, lumbar punctures, urine catheterization, venipuncture) in patients 0-6 months of age from 50% to 80% in the YNHH Pediatric Emergency Department within 12 months.

Background: Pain is the most common adverse event during minor procedures performed in the pediatric Emergency Department. Inappropriate procedural pain management in young infants can lead to unsuccessful procedures, patient discomfort, and parental dissatisfaction. Many studies have shown that oral sucrose is associated with an overall decrease in pain responses in young infants. Oral sucrose is inexpensive, non-invasive, and easily administered. Our objective is to increase oral sucrose use for pain management during common invasive procedures at the YNHH Pediatric Emergency Department in patients 0-6 months of age from 50% to 80% within 12 months.

Methodology: We initiated this project in June 2018 at an urban tertiary pediatric ED. We used the Model for Improvement (Plan-Do-Study-Act (PDSA)) methodology for this QI project. Baseline data was obtained prior to initiation of QI project, which consisted of percentage of oral sucrose use for common invasive procedures in the PED. We observed the process of ordering oral sucrose for common minor procedures, from triage to the time of the procedure. Furthermore, we identified key drivers that would lead to appropriate use of oral sucrose for this population: identification of patient needing procedure, family expectations, PED staff education, and order ease of use. (Figure 1) We conducted multiple interventions: (1) provider (attendings, fellows and nurse practitioners) education; (2) nurse education; (3) reporting at weekly management meetings; (4) resident education (5) technician education; (6) ordering process modification; (7) visual aids; and (8) EMR order set. We collected weekly data to inform PDSA cycles. (Figure 2) We utilized statistical process control for analysis.

Results: Our study demonstrated improvement in oral sucrose use for pain management for common invasive procedures in patients 0-6 months of age from 50% to 90% over the course of 12 months. (Figure 3). Specifically, we found a significant improvement in oral sucrose use for patients ages 4-6 months (21% to 64%).

Conclusion: Using QI methodology and a multidisciplinary group we were able to identify barriers and study interventions to increase oral sucrose use in patients 0-6 months old. Our intervention led to a 40% increase in oral sucrose use in this age group.