Nurses in the emergency department at NewYork-Presbyterian/Morgan Stanley Children’s Hospital are pioneering techniques – including the use of iPads – to improve the patient experience by eliminating or minimizing pain. The Children’s Comfort Program (CCP) has expedited assessment and treatment of pain and has implemented the use of innovative techniques, such as using an iPad, to minimize discomfort and anxiety during procedures.
“Whether a child comes to us with a broken arm, severe asthma or any medical emergency, we need to do all we can to eliminate the pain they are feeling and get them the care they need,” says Bernadette O’Brien, R.N., vice president of operations at NewYork-Presbyterian/Morgan Stanley Children’s Hospital. “This program has been very successful, with positive feedback from parents and improvements in Press Ganey surveys of pain management.”
The CCP initiative has implemented procedures for expediting pain care, allowing nurses to administer pain relief immediately after pain has been assessed and to administer anesthetizing gel in anticipation of a suture repair. The CCP team is also developing wearable ID-badge-sized cards with different pain scales that will allow them to assess pain in children of all ages and developmental stages.
iPads Help Minimize Pain During Procedures
A major focus for the CCP has been improving children’s experiences during procedures. In anticipation of treatment, children may become anxious – which not only worsens their experience but could exacerbate their condition and make it more difficult to complete the procedure.
One particularly successful strategy embraced by the CCP team is the use of iPads. With a myriad of entertainment, education, and distraction options geared to all ages and developmental stages – music, videos, interactive games, etc. – the device has proven to be an excellent tool for helping children cope, thereby improving their overall experience. It has also helped the care provider by calming the child so that the procedure may be completed faster and more efficiently and by reducing or eliminating the need for physical restraint.
In addition, the CCP team has worked to implement techniques, such as guided imagery and positions of comfort. “‘Positions of comfort’ describes an approach that, instead of using physical restraints, invites children to sit in their parent’s lap or hug them during what can be an unfamiliar and frightening situation,” says Bonnie Corbett, R.N., director of nursing in the pediatric emergency department at NewYork-Presbyterian/Morgan Stanley Children’s Hospital. “This family-centered approach helps parents feel included in their child’s care.”
These approaches are particularly important for asthma patients needing a nebulizer treatment, including the more severe asthmatics requiring biPAP or CPAP. Minimizing their anxiety is crucial since anxiety may worsen their symptoms and interfere with treatment. Using the iPad and other techniques, clinicians help calm and settle these patients so that they are more receptive to these treatments, preventing further deterioration of their conditions and eliminating the need for more invasive interventions such as tracheal intubation and ventilation.
Since the program began, the Children’s Comfort Program has seen favorable results. The Press Ganey score for how well pain was controlled improved an impressive two full points, from 76.6 in 2009 to 78.6 in 2010. There has also been ample anecdotal evidence that the initiatives have made an impact, with more clinicians using positions of comfort and fewer children requiring restraint to complete procedures. The iPad intervention has been so successful that NACHRI (National Association of Children’s Hospitals and Related Institutions) invited CCP team members to present at its conference in March 2011. The initiative has been praised by NewYork-Presbyterian Hospital leadership, which plans on implementing CCP’s strategies hospital-wide.
Material adapted from NewYork-Presbyterian Hospital/Columbia University Medical Center.