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Emla Cream For Atraumatic Care
Emla Cream For Atraumatic Care
Emla Cream For Atraumatic Care
NEW GRADUATE RESIDENCY PROGRAM, MUSC Shelley Grosso, RN BSN Jenny Breeden, RN BSN
INTRODUCTION
MUSC Excellence
MUSC excellence is the adoption of the Best Practices at MUSC. Simultaneously in 2006 the Institute of Psychiatry adopted the Engagement Model which includes best practices such as: Environmental modifications Unit rules and healing language Trauma informed care and healing milieu Patient/ family involvement in treatment decisions
Atraumatic Care
Donna Wongs Conceptual Model of Atraumatic care defines atraumatic care in healthcare settings as care that eliminates or minimizes the psychological and physical distress experienced by children and families. Within this framework, there are three principles: Prevent childs separation from family Promoting a sense of control Minimizing bodily injury and pain1
The use of EMLA cream on pediatric patients prior to venipuncture and/or intravenous catheterization. EMLA cream is an anesthetizing agent used to reduce the pain associated with minor hospital procedures. A less painful venipuncture is related to higher success in gaining venous access2.
Study #1
SAMPLE: 73 boys and 63 girls, ages 3-12 years old
RESULTS: The placebo slightly decreased the report of pain. EMLA cream had a distress reducing effect and a larger decrease in reported pain.
A study comparing the use of EMLA cream and a placebo cream along with other non-pharmacological interventions to aid with reported and observed distress associated with venipuncture.
SAMPLING METHODS: Subjects separated into five experimental groups and one control group 7
Study #1
Main Ideas: o Pain and distress associated with minor invasive procedures in children can be reduced by topical application of EMLA cream. o EMLA cream surpasses psychological interventions (such as distraction, music, breathing exercises, or watching a movie) as well as non-pharmacological interventions (procedural information and distraction). o A placebo cream was used for comparison and an identical scale for pain score was used for all participants in the study Conclusions: o There is a significant difference between the pain scores of those who received EMLA cream and those who did not. o Quantifiable advantage of EMLA cream in reducing the negative feelings o The explanation to the patient that EMLA cream reduces pain showed a decrease in patient distress o Placebo cream minimally diminished the report of pain, but overall EMLA cream was the most effective in reducing pain and distress8
Study #2
DESIGN: Descriptive Quantitative Design
RESULTS: Advantages include ease of use and increased patient rapport. Having access to EMLA was the main barrier.
A study investigating whether heat after application of EMLA cream will ultimately promote atraumatic care in pediatric patients.
SAMPLE METHODS: A Convenience sample was selected including children with medical surgical diagnoses who needed vascular access but excluding children with mental disability.
Study #2
Main Ideas: o Venipuncture is one of the most painful procedures that is frequently performed o EMLA cream can cause initial vasoconstriction that may hinder intravenous catheterization, however adding heat should encourage vasodilation o Wong-Baker FACES pain rating scale was used to report pain and the SonoSite iLook 25 was used to measure vein size Conclusions: o The application of heat counteracted the vasoconstriction effect of EMLA cream o The use of EMLA cream followed by heat increases peripheral intravenous catheterization success rate o Atraumatic care was established with an 80% first-attempt success rate10
Study #3
SAMPLING METHODS: Pediatric nurses surveyed with 20-item questionnaire
RESULTS: Advantages include ease of use and increased patient rapport. Having access to EMLA cream was the main barrier.
A study on the availability, use, and the perception of pediatric nurses on EMLA cream for venipuncture and intravenous catheterization.
11
Study #3
Main ideas: o Analyzing the availability of EMLA cream for pediatric RNs o Identifying driving forces for EMLA cream usage o Understanding the barriers to EMLA cream usage Conclusions: o The practice of EMLA cream in pediatric RNs is inconsistent o When EMLA cream is not stocked on the floor and had to be obtained from pharmacy, it was not often used o Driving forces included the knowledge that venipuncture is painful for pediatric patients, and the fact that EMLA is easy to use o Restraining forces have a greater influence on a nurses perception than driving forces o Length of time needed to obtain EMLA cream = largest barrier o Another restraining force was the lack of in-depth training on EMLA12
INTRODUCING CHANGE
Decreasing/Eliminating Resistance
Offer a clear and concise statement of the goals of the new protocol Eliminates any miscommunication or misunderstandings Provide open discussion staff meetings about the new protocol: Teach the nursing staff that this new practice gives them more input in patient care Encourage questions and ask staff to voice feelings, either negative or positive, about change Directly deal with controversy Meet with those who oppose the new practice Ask if they have ideas on ways to improve the implementation of the new practice Assign them to a quality improvement team that focuses on the process of implementing the protocol
SUMMARY
References
Britt, R.B. (2005). Using EMLA cream before venipuncture. [Electronic Version]. Nursing 2005, 1, 17. Hockenberry, M. J., & Wilson, D. (2007). Wongs nursing care of infants and children (8th ed). St. Louis: Mosby. Huff, L., Hamlin, A., Wolski, D., McClure, T., Eliades, A.B., Weaver, L., & Shelestak, D. (2009). Atraumatic care: EMLA cream and application of heat to facilitate peripheral venous cannulation in children. Issues in Comprehensive Pediatric Nursing, 32, 65-76. May, K., Britt, R.B., & Newman, M. M. (1999). Pediatric registered nurse usage and perception of EMLA [Electronic Version]. Journal of the Society of Pediatric Nurses, 4(3), 105-112. Rogers, T.L., & Ostrow, C.L. (2004). The use of EMLA cream to decrease venipuncture pain in children [Electronic Version]. Journal of Pediatric Nursing, 19(1), 33-39. Tak, J.H., & van Bon., W.H.J. (2006). Pain- and distress-reducing interventions for venipuncture in children [Electronic Version]. Child Care Health Development, 32(3), 257-268.