Decreasing Pain in Hospitalized Patients by Increasing Topical Anesthetic Use for Peripheral IVs

Abstract

Introduction: Venous access is a common source of pain for hospitalized patients. Topical anesthetics are effective at decreasing needle pain, can improve success rate, and decrease procedure time; however, use before peripheral intravenous line (PIV) placement is inconsistent. The aim was to reduce pain experienced by hospitalized pediatric patients by increasing topical anesthetic use for PIV placement from a mean of 11% to 40% within 6 months. Methods: The Model for Improvement was utilized. An institutional clinical pathway and PIV order panel were developed. Pre-checked orders for topical anesthetics were added to order sets. Visual aids were placed on IV carts, including reminders for anesthetics, pathway use and scripting examples. Nurses received individual feedback. Statistical process control charts were posted weekly on daily management system boards on medical-surgical floors, and data were shared at daily nursing huddles to increase awareness of performance and discuss opportunities for improvement. Results: Topical anesthetic use for PIV placement increased from a mean of 11% to 46%. Documentation of comfort measures during PIV placement increased from a mean of 6% to 13%. The percentage of PIV placements with an order for a topical anesthetic in the electronic health record increased from a mean of 14% to 54%. PIV procedures with documentation of placement attempts increased from a mean of 47% to 70%. Conclusions: Through systems and culture change, awareness of the importance of pain prevention for venous access procedures increased, and patient-centered care improved with greater collaboration between nurses, providers, and families for venous access planning.