Quality Improvement Projects in Hospitals

Pain management initiatives have become a rising protocol for hospitals across the nation. Hospitals are starting to focus more on a patient’s pain and discomfort and what the leading causes may be during their stay at the hospital. Hospitals are scored using a system they have in place called the Joint Commission on Accreditation of Healthcare Organizations (JACHO). To help find out how a patient stay was, the Joint Commission provides patients with a survey at the end of their stay at a hospital facility to evaluate their experiences and what happened during that visit that either caused them the most pain, or discomfort, and if there is something they can do to address it or fix it for other patients. The survey is given to help determine what the facility can do in the future to increase patient satisfaction. The survey process is not only data-driven, but patient-centered, and it is focused on evaluating the actual care processes of a patient’s time at the hospital. The objectives of the survey are to evaluate the organization and to also provide education and “good practice” guidance that will help the staff to continually improve on performance for the hospital to be able to increase their scores1. By creating more awareness for these quality improvement projects, more facilities are able to start their own initiatives and gear them to a certain set of patients who need it the most. Some of these projects are being done for patients who are needle phobic or experience pain during routine needle procedures, and most commonly, IV starts. There are many clinical studies that have been conducted on pain management and patient satisfaction that show that IV insertion is one of the leading causes of pain during the patient’s hospital visit2. This can cause symptoms most commonly known as needle phobia.

Needle Phobia

What is Trypanophobia3 (need small number here) or needle phobia? And how does it affect a person? Needle Phobia usually stems from a prior medical procedure the patient had such as an IV start or routine needle injections. Needle phobia symptoms include3: dizziness, fainting, anxiety, insomnia, panic attacks, high blood pressure, racing heart and feeling physically or emotionally violent. These experiences may be extremely traumatizing for both younger children and adults and can create vivid memories resulting in lifelong needle phobia. With this knowledge in mind, needle phobia symptoms are a factor that must be taken seriously. Especially when a patient is in a situation that requires a needle procedure. People from all walks of life may at some point need to face these needle phobia symptoms and will require tools on how to overcome the fear of needles and injections.

A New Procedural Pain Management Tool and Initiatives

Along with the protocols for scoring patient satisfaction, there are also initiatives that hospitals have created to provide patients with more comfort, or security, while they are there. These initiatives are similar too guidelines that each clinical staff member follows for every single patient that they see or for a certain set age range. For example, Wolfson Children’s created an initiative called the PANDA4 Initiative that stands for: “prepare” the patient, “analgesia” to reduce or eliminate pain, “new” technology, “distraction” and “allow” parents to hold their child in their arms during the procedure. Some people think that it’s just an IV stick, or “poke” and it is over quickly and that it won’t be an issue to the child or adult and that it’s not really an issue or something that needs to be address. However, many hospitals based on their scoring have noticed that IV’s really are a big deal and they are causing a lot of pain and anxiety to not only the children but to the adults as well. By creating these initiatives clinical staff are becoming more aware of their patients’ needs and how to address them. The PANDA Initiative is a great way to help clinical staff address a patient’s needs. Each one of these steps plays an important role in helping to limit the anxiety and fear that comes along with medical procedures or for people who fear needles which can ultimately create a needle phobic patient. By discussing each one of these steps and how each one plays its own important role to help patients, clinical staff can help to increase their patient satisfaction and limit the traumatic experiences that patients have in their care.  While utilizing instructions based on current practice, new research, and techniques these may help patients and families cope with the stressors of surgery and routine needle procedures, by determining which patients may benefit from a medical or child life preoperative visit or need them during the time of their visit is of utmost importance.

Ways to Help Overcome the Fear of Needles and Common Medical Procedures

Medical care is essential to millions of people and routine needle procedures are generally part of the standard practice that comes with the territory of getting the routine or emergency care that people need. Patients will often ask medical providers if there are ways to avoid getting poked by a needle, ways to not feel the pain of that needle, and if there are ways to cope with getting a needle procedure if they do have to feel the prick of a needle. Patients may also ask if a virtually pain free experience is possible when it comes to needle insertion.

To answer some of these questions there are tools that exist to aid with the pain associated with routine, or common needle procedures. Whether it be a cream, spray or medication there is a solution to help decrease a patient’s pain and methods to help with distracting the patient to help them feel or experience less pain. To address how to overcome fear of needles and injections, it all starts with the patient. As a patient or guardian of a patient with needle phobia, by taking charge of their medical care you will be able to ask questions to the medical provider on ways to help reduce pain, what tools or medications they have available and then consider what your best options are, and what is best for you or the person you are taking care of. When it comes to your medical care don’t be afraid to stand up for yourself, so you don’t miss out on getting the care you need and keeping your body and mind healthy. Listed below are some tools used at medical facilities to address the pain that can be associated with common needle procedures.

Preparing the Patient

When it comes to preparing the patient, most psychological symptoms of anxiety can occur during any given routine or emergency medical procedure. If a patient is needle phobic or anxious it can possibly increase the length of the procedure, taking a nurse or doctor longer than needed to attend to the patient making wait times longer for other patients who need to be seen. When a clinical staff member is taking extra time with an overly anxious patient it can cause problems such as: increasing the difficulty of the procedure and physical harm may be caused to the patient or clinical staff member.  Why do you think it is that doctors and emergency staff in life or death situations tell the bystanders that come in with the injured patient to stay calm and wait outside? Why do you think they aren’t allowed in the room during these procedures? One of the main reasons is because they need a calm, anxious free environment to work on the patient, so that they can give them the best care that they possibly can in these already highly stressful situations. By preparing the patient ahead of time for what’s to come, whether that is an IV or undergoing an invasive medical procedure, the patient has more of an opportunity to know the steps you plan to take and the possible outcomes. This may help to reduce as many negative outcomes as possible by helping the patient to be more relaxed and less anxious. Research shows and supports the notion that by preparing the patient prior or by providing preprocedural intervention, that this may help to reduce the anxiety felt by the patient5. This leaves the remaining question: of what type of methods are best for preparing a patient? Each patient is different and will need different types of preparation whether that be preprocedural intervention to help decrease their anxiety and quality of life, especially for different procedures or if they are given specific distraction methods or medical tools to decrease their pain and anxiety levels.

Distraction Techniques: How They Play an Important Role

This is where distraction methods enter. When it comes medical procedures being performed on a child, adolescent, or even and adult distraction methods can play a vital role in the overall patient experience. By first explaining what is going to happen, they then have a better understanding of what is to come and what may be experienced during the procedure. Preparing the patient and distraction methods go hand in hand. With dealing with pediatric patients and distraction techniques for them, it is great when a facility is equipped with age appropriate distraction tools, or methods and staffed with Child Life Specialists, as they are trained in the art of distraction and helping the child, or adolescent to understand what is about to happen, and create a calm and less stressful environment for the child. Most child life staff are usually prepared and equip with books, smart devices to play videos on, sing a song or to play an interactive game that helps to distract the child from what is happening. They are a wonderful asset to have in the room for pediatric ages and are a huge advantage for those overly anxious children or teens. Sometimes the simplest ideas work the best but it’s always a plus to be creative as each patient is unique and will need different levels of distraction techniques, and sometimes one isn’t enough. Other methods of distraction consist of providing the child something to hold on to, like their favorite stuffed animal or toy while also making sure they are able to and see or touch their parent, while also considering the position the patient is in when getting a medical procedure done. When it comes to dealing with children the child needs to feel safe and comfortable in their environment. There a few different positions that can be beneficial. Laying in the supine position or lying flat on the bed can be a comfortable start. If the parent is available to assist and not be in the way during the procedure this is a common suggestion nurses or child life staff usually suggest for some pediatric patients who are getting an IV as they can have the child sit in their lap facing away from the procedure. It is very important to know or figure out what will make the patient more comfortable. Some patients like to see what is happening and some do not. Sometimes, by not looking at the procedure this can help reduce the pain a patient feels or help to create a virtually pain free experience, while also using pain management tools or devices to assist with the medical procedure. At the end of the day, it is all about the patient experience and trying to make a scary, anxiety-filled situation more tolerable. This isn’t always an option for some nurses who do not have the time, or the work load is substantial for the day. A study does show6 that when health care providers don’t have the time or make the time for a patient or do not incorporate comfort positions or distraction techniques, that this can add more distress to the patient rather than help to relieve a patient’s pain and anxiety. By incorporating these techniques into their daily patient routine or for the patients that really do need just a little more time, this could help to improve better health care outcomes for not only the hospital but the overall patient experience as well, if they made it a general rule to do this for all patients such as the PANDA4 initiative does at Wolfson and Children’s Hospital in Jacksonville Florida.

Tools for Numbing for IV Insertion

Many children view receiving needles as one of the most traumatic aspects of being in the hospital, so if there are ways to help decrease these traumatic experiences or ways of decreasing their pain and anxiety why aren’t more hospitals and clinical staff doing more to help them? Well, some facilities are, as mentioned earlier with the quality improvement projects and pain management initiatives. In recent years the medical community has taken a sincere interest in the importance of managing their patients’ pain especially when that pain is associated with IV insertion. Many facilities such as Nicklaus Children’s Hospital7 formerly known as Miami Children’s Hospital, are adopting different pain management initiatives to improve their patients’ experience at the adolescent age by anaesthetizing the insertion site prior to IV insertion. For years hospitals have been using products such as L.M.X.4®, EMLA®, and Pain Ease® Spray, which are used prior topically on the patient’s skin to create an anesthetic effect at the site of injection prior to IV insertions. These tools may take a longer duration of time to achieve a full anesthetic effect, in turn, making busy hospital staff wait to complete necessary procedures. However, another tool in the pain care initiatives is called the J-Tip™ Needle-free injector, which cuts that wait time down tremendously!

Jet Injection Technology and the J-Tip Needle-Free Injector

What is the J-Tip? First, jet injection technology has been used for medication administration for more than 50 years. The first injectors were bulky, large, loud, and most would probably say they hurt. They were primary used for mass vaccinations in the military and in school settings. The J-Tip is a much smaller device when compared to the previous jet injection devices that were used. The J-Tip is a needle-free device that uses jet injection technology to administer medication into the subcutaneous tissue providing an anesthetic effect for IV insertion or other routine needle procedures and can create a virtually pain free experience for the patient. The J-Tip needle-free jet injection technology works by using compressed CO₂ gas to propel buffered or MPF lidocaine into the subcutaneous tissue without the use of a needle. The J-Tip is a onetime use, sterile, completely needle-free device, that once activated only takes 1-2 minutes for an anesthetic effect to occur and can last up to 15-20 minutes. The J-Tip can be used in multiple departments throughout the hospital and on all ages. Hospitals across the country have seen great success using the J-Tip facility-wide and it is a great tool to have to create a virtually pain free option for your patients when you don’t have a lot of time and need something to work quickly and effectively. By using the J-Tip you are not only limiting needle stick injures for your medical staff, but you are creating a needleless environment for your already overly anxious or needle phobic patients. By choosing the right tools or devices and combining them with age appropriate distraction techniques clinical staff can help to minimize the trauma that patients feels when trying to get the medical care they need to stay healthy. By working together to create more options for patients we are also helping to make scary, anxious situations less traumatic and more positive.


  1. The Joint Commission (June 1, 2018) Measures https://www.jointcommission.org/core_measure_sets.aspx
  2. Cognitive-behavioral interventions for IV insertion pain. Jacobson 2006 December Kent State University College of Nursing, Kent, Ohio, USA.https://www.ncbi.nlm.nih.gov/pubmed/17216895;
  3. Cirino, E (Oct 20, 2017), Trypanophobia, Retrieved: Apr 13, 2018 https://www.healthline.com/health/trypanophobia https://aornjournal.onlinelibrary.wiley.com/doi/epdf/10.1016/S0001-2092%2806%2964000-3
  4. Daily Record Staff (Tuesday, March 23, 2010) Wolfson Children’s Hospital employees develop ‘ouchless’ blood draws. https://www.jaxdailyrecord.com/article/wolfson-childrens-hospital-employees-develop-ouchless-blood-draws
  5. Patient psychologic preparation for invasive procedures: an integrative review. Moline LR[Author] 2000 Dec;18(4):117-22 Intensive Care Unit, St John’s Mercy Medical Center, St Louis, Missouri, USA. https://www.ncbi.nlm.nih.gov/pubmed/11995292
  6. Comforting strategies and perceived barriers to pediatric pain management during IV line insertion procedure in Uganda’s national referral hospital: A descriptive study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572629/
  7. Garlesky, Cindy MSN, ARNP, CEN , RN-BC (Spring 2008), Pursuit of Excellence P. 5 Needle Free Jet Injection Technology: A New Procedural Pain Management Tool, Retrieved: Apr 19, 2018 from: https://www.nicklauschildrens.org/pdf/NNSPG08.pdf