降低學齡前期兒童靜脈注射疼痛之方案

Reducing the Pain of Intravenous Injections in Preschool Children

背景：靜脈注射是學齡前兒童住院中重要的壓力源，本院兒童內科病房之學齡前期兒童約佔85%，其中有71.0%的兒童在靜脈注射時出現中重度疼痛行為反應。經調查後發現可能原因為護理人員未於靜脈注射前提供降低疼痛藥物、未依年齡層提供非藥物性處置及治療室擺設過於單調。目的：學齡前期兒童靜脈注射中重度疼痛比例由71.0%下降至36.0%，依成員改善能力設定目標50%為設定值。解決方案：舉辦護理人員在職教育、修訂兒科靜脈注射流程、給予局部麻醉的藥物及非藥物處置（包括改善治療室設備和增購輔助工具）。結果：本專案執行後中重度疼痛行為反應由71.0%下降至19.7%，超過預期目標。結論：藉由本實證為基礎之專案，可有效降低學齡前期兒童靜脈注射過程之重度疼痛，提升兒童照護品質。

Background & Problems: Peripheral intravenous catheter insertion is a significant source of stress for preschoolers during hospitalization. An average of about 85% of pediatric patients at our general pediatric unit are preschoolers. An average 71% of these exhibit severe pain-related behavior during intravenous insertions. The factors influencing this pain experience may include inappropriate administration of analgesics by nurses, non-pharmacologic pain management, and inappropriate clinical settings.Purpose: This project worked to develop a strategy to reduce the incidence of severe injection pain in preschool children from 71.0% to 36.0% and to achieve a capacity improvement target of 50%.Resolutions: We implemented the following: 1) arranged a relevant training program for pediatric nurses; 2) revised hospital standards for pediatric intravenous insertions; and 3) enhanced analgesic administration and non-pharmacologic pain management through creating child-friendly clinical settings and providing interactive toys.Results: After implementing the abovementioned interventions, the incidence of severe pain-related behavior in pediatric patients decreased from 71.0% to 19.7%, a result that greatly exceeded expectations.Conclusions: This project demonstrated an effective approach to reducing severe intravenous-insertion pain in preschoolers and increasing pediatric care quality.