Educational Outreach to Reduce Immunization Pain in Office Settings

Children's Hospital Boston, Department of Anesthesia, Perioperative and Pain Medicine, 300 Longwood Ave, Boston, MA 02115, USA.
PEDIATRICS (Impact Factor: 5.47). 11/2010; 126(6):e1514-21. DOI: 10.1542/peds.2010-1597
Source: PubMed


The goal was to examine the impact of a teaching module on immunization pain reduction practices in pediatric offices 1 and 6 months after the intervention.
Fourteen practices were selected randomly to receive a 1-hour teaching session on immunization pain reduction techniques, and 13 completed the study. Before the intervention, telephone interviews were conducted with parents concerning their children's recent immunization experiences. At 1 and 6 months after the intervention, parents of children who had recent immunizations were interviewed by using the same questionnaires. Clinicians also were surveyed at baseline and at 6 months.
A total of 839 telephone interviews and 92 clinician surveys were included. Significant changes from baseline were identified at 1 and 6 months after the intervention. At 1 month, parents were more likely to report receiving information (P = .04), using strategies to reduce pain (P < .01), learning something new (P < .01), using a ShotBlocker (P < .01), using sucrose (P < .01), and having higher levels of satisfaction (P = .015). At 6 months, all rates remained significantly higher than baseline findings (all P < .01) except for satisfaction. Clinician surveys revealed significant increases in the use of longer needles, sucrose, pinwheels, focused breathing, and ShotBlockers at 6 months.
A 1-hour teaching session had measurable effects on the use of pain-reducing strategies at 1 and 6 months after the intervention. This research supports the hypothesis that small-group teaching sessions at the site of care can be associated with changes in practice behaviors.

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    • "Inadequate pain management can lead to negative experiences with vaccination and parental noncompliance with vaccination schedules [6]. Parents are dissatisfied with current analgesic practices [2] [7] and when pain-relief is provided to their children, both parents and health care providers report better satisfaction with medical care [8]. Under-utilization of analgesics during vaccination is largely attributed to the additional time and resources needed to implement them [2]. "
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    ABSTRACT: Sucrose solutions are analgesic in infants. Oral rotavirus vaccine contains sucrose, however, it is not known if it possesses analgesic properties. The objective was to compare the analgesic effectiveness of rotavirus vaccine to sucrose solution when administered prior to injectable vaccines. Infants 2-4 months of age receiving oral rotavirus vaccine and two separate injectable vaccines on the same day were randomized to rotavirus vaccine (Rotarix™) first followed by the injectable vaccines and sucrose (Tootsweet™) afterwards, or vice versa. Pain was assessed by blinded raters using the Numerical Rating Scale (NRS, range 0-10) (parents, clinicians), or Modified Behavioural Pain Scale (MBPS, range 0-10) and cry duration (observers). Data were analyzed using t-tests or χ(2)-tests; Bonferroni correction was applied to correct for multiple comparisons, as appropriate. Altogether, 120 infants participated: 60 were randomized to rotavirus vaccine first. Groups did not differ in demographics, including; age (p=0.448) and sex (p=0.464). The mean pain score (standard deviation) for both vaccine injections did not differ between infants given rotavirus vaccine first versus sucrose solution first: observer MBPS, parent NRS and clinician NRS scores were 7.4 (1.6) vs. 7.7 (1.6), 4.9 (2.1) vs. 5.8 (2.1), and 4.2 (2.1) vs. 4.6 (2.2), respectively. Similarly, there was no difference between groups in cry duration. Rotavirus vaccine did not differ from sucrose solution in reducing injection-induced pain. Based on the findings, it is recommended that rotavirus vaccine be administered prior to injectable vaccines in infants aged 2 and 4 months. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Apr 2015 · Vaccine
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    • "It is however possible that the pain control measures apparent during vaccinations as seen in the posted videos are not representative of all vaccinations, as the act of videotaping precludes holding the infant, breastfeeding or administering sucrose unless a tripod or third party is available to operate the camera. However, the observed infrequent use of recommended pain management strategies are concordant with results of published surveys of health care professionals’ pain management practices during immunization [4,7,25,26] as well as a recent observational study of pain management practices in infants during immunization [38]. This highlights that, so far, current evidence and guidelines relating to pain management strategies, most of which has been available prior to the date of the first YouTube posting, have been unsuccessful in changing immunization pain practices. "
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    ABSTRACT: Background Early childhood immunizations, although vital for preventative health, are painful and too often lead to fear of needles. Effective pain management strategies during infant immunizations include breastfeeding, sweet solutions, and upright front-to-front holding. However, it is unknown how often these strategies are used in clinical practice. We aimed to review the content of YouTube videos showing infants being immunized to ascertain parents’ and health care professionals’ use of pain management strategies, as well as to assess infants’ pain and distress. Methods A systematic review of YouTube videos showing intramuscular injections in infants less than 12 months was completed using the search terms "baby injection" and "baby vaccine" to assess (1) the use of pain management strategies and (2) infant pain and distress. Pain was assessed by crying duration and pain scores using the FLACC (Face, Legs, Activity, Cry, Consolability) tool. Results A total of 142 videos were included and coded by two trained individual viewers. Most infants received one injection (range of one to six). Almost all (94%) infants cried before or during the injections for a median of 33 seconds (IQR = 39), up to 146 seconds. FLACC scores during the immunizations were high, with a median of 10 (IQR = 3). No videos showed breastfeeding or the use of sucrose/sweet solutions during the injection(s), and only four (3%) videos showed the infants being held in a front-to-front position during the injections. Distraction using talking or singing was the most commonly used (66%) pain management strategy. Conclusions YouTube videos of infants being immunized showed that infants were highly distressed during the procedures. There was no use of breastfeeding or sweet solutions and limited use of upright or front-to-front holding during the injections. This systematic review will be used as a baseline to evaluate the impact of future knowledge translation interventions using YouTube to improve pain management practices for infant immunizations.
    Full-text · Article · May 2014 · BMC Pediatrics
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    • "gate pain in their infants is therefore important. It has previously been demonstrated that teaching paediatricians and public health nurses leads to demonstrable increases in the utilization of interventions to reduce vaccination pain [4] [13]. Based on this prior research and the current findings, we recommend additional measures to target clinicians to achieve even higher utilization rates. "
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    ABSTRACT: Analgesic interventions are not routinely used during vaccine injections in infants. Parents report a desire to mitigate injection pain but lack the knowledge about how to do so. The objective of this cluster randomized trial was to evaluate the effect of a parent-directed prenatal education teaching module about vaccination pain management on analgesic utilization at future infant vaccinations. Expectant mothers enrolled in prenatal classes at Mount Sinai Hospital, Toronto were randomized to a 30-minute interactive presentation about vaccination pain management (experimental group) or general vaccination information (control group). Both presentations included a Powerpoint™ and video presentation, take-home pamphlet, and 'Question and Answer' period. The primary outcome was self-reported utilization of breastfeeding, sugar water or topical anesthetics at routine 2-month infant vaccinations. Between October, 2012 and July, 2013, 197 expectant mothers from 28 prenatal classes participated; follow-up was obtained in 174 (88%). Maternal characteristics did not differ (p>0.05) between groups. Utilization of one or more pre-specified pain interventions occurred in 34% of participants in the experimental group compared to 17% in the control group (p=0.01). Inclusion of a pain management module in prenatal classes led to increased utilization of evidence-based pain management interventions by parents at the 2-month infant vaccination appointment. Educating parents offers a novel and effective way of improving the quality of pain care delivered to infants during vaccination. Additional research is needed to determine if utilization can be bolstered further using techniques such as; postnatal hospital reinforcement, reminder cards, and clinician education.
    Full-text · Article · Apr 2014 · Pain
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