Improving the Venipuncture Experience in Children with Autism Spectrum Disorder

Abstract

BACKGROUND: Children with autism spectrum disorder (ASD) may experience heightened fear and distress when accessing health care services, which can result in noncompliance with procedures. Management of needle pain and fear is particularly important for children with ASD given their higher utilization of health care services, neurodiversity, and limited coping skills. PURPOSE: The purpose of this quality improvement project was to implement and evaluate evidence-based interventions to improve procedural care processes and challenging behaviors in children with ASD undergoing venipuncture. METHODS: The Iowa Model was used to guide evidence-based practice (EBP) improvement in the care of children with ASD undergoing venipuncture at a pediatric procedure and imaging suite of a children's hospital at an academic medical center. Based on evidence from the literature, patient and family preferences, and clinician input, a practice change that included individualized care, patient and family preparation, clinician preparation, and system design was implemented. RESULTS: Sixteen clinicians, including RNs, medical assistants, and nursing assistants, demonstrated increased knowledge and comfort in caring for children with ASD, improved availability of resources, improved utilization of procedure support cues and workflows, and improved outcomes. Similarly, 20 parents of children with ASD demonstrated improved preparedness, staff comfort, appointment flow, supportive environment, and awareness of individual needs and communication. Process measures were used to identify opportunities for improvement, select implementation strategies, and design the practice change. CONCLUSIONS: Improvement in individualized care, patient and family preparation, clinician preparation, and system design can optimize care of children with ASD undergoing venipuncture procedures. An EBP process model and multiple targeted implementation strategies may facilitate the adoption of interventions to support these children.