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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
Rationale:

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.

Methods:

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.

Results:

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. 

Conclusions:

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.