Using quality improvement methods to increase use of pain prevention strategies for childhood vaccination

Table 1 Primary care clinic culture related to pain prevention: Familiarity, beliefs, and barriers to use at baseline (Faculty MD, n = 28; Resident MD, n = 98; APN, n = 12; Nursing staff, n = 28)

		Percent endorsement by group
Level of cultural familiarity	Pain prevention strategy	APNs/Nurses	Physicians
Most well known	Distraction
	Topical anesthetic creams
	Nonnutritive sucking
Most commonly trained	Swaddling
	Topical anesthetic creams
	Distraction
	Nonnutritive sucking
Most typically used in practice	Distraction
	Pre-medication
	Nonnutritive sucking
Specific belief
It is important for me, personally, to prevent pain during vaccinations		64%	56%
There are effective ways to prevent vaccination pain		57%	61%
Pain from vaccinations results in harmful and lasting effects		14%	11%
Pain during vaccinations is “just part of the process”		43%	17%
Learning to cope with pain (from vaccinations) benefits children		50%	17%
Most Salient Reported Barriers to Pain Prevention Use
Lack of accessibility of pain prevention materials or tools in the clinic
Not having enough time
Lack of education among staff