Helping Children Cope With Discomfort Associated With Skin Prick Testing In a Pediatric Setting: A Quality Improvement Report
Sunday, March 2, 2014
Exhibit Hall B (Convention Center)
Amanda Troger, BSN, RN, Humaira Robinson, BSN RN, Sonia C. Mancia, RN, Hemant P. Sharma, MD MHS FAAAAI, Katherine Kelly, PhD, RN

Patients undergoing skin prick testing (SPT) in a Pediatric Allergy Clinic can experience significant pain and itching. Incorporating comfort measures into clinical care may help improve the patient experience through a performance improvement process.


We administered patient/parent surveys to identify and evaluate parent/nurse-initiated comfort measures used during SPT application (“SPT”) and 15-minute waiting period (“wait”). A visual analog scale assessed patient’s coping during SPT and wait (0 = very poor, 5= very well). Surveys were emailed to parents within 1 week of testing. After obtaining baseline data, nurse-initiated comfort measures were implemented. Findings were shared with team members monthly to increase use of comfort measures reported most effective.


44 surveys (59% response rate) have been returned to date. Data are reported as percentage of patients/parents who rate the patient’s coping as 4 or 5. Baseline data for comfort during SPT: nothing used by parent, 79%; home comfort measure (electronic device, coloring), 75%. Wait baseline: nothing used by parent, 69%; home comfort measure, 70%. The first nurse-initiated comfort measure implemented, Buzzy® (commercially-available vibrating device) resulted in 63% for SPT and 88% for wait. Other nurse-initiated comfort measures, including fans and electronic tablets, are now being evaluated. 


A nurse-initiated comfort measure, Buzzy®, may improve a child’s coping during the 15-minute wait, but not during skin test application. Continued data collection will systematically evaluate additional nurse-delivered comfort measures. Ongoing process evaluation offers promise to improve comfort for children undergoing SPT.