Boston Children’s Hospital Emergency Department

Boston, Massachusetts

The 46-bed Boston Children’s Hospital created an ED Needle Pain Protocol order set to empower the nurse to initiate age-appropriate analgesia using evidence- based best practices and a variety of pharmacological interventions. These orders are placed as standard of care.

The J-tip, a subdermal local anesthetic with a needle-free delivery system, is used to administer 1 percent buffered lidocaine sodium bicarbonate to children 6 months and older and is especially effective in our ED environment when rapid local anesthesia is needed. A notable decline in J-tip utilization rate led to a focused QI initiative with an aim to increase usage by 50 percent by October 2023. ED nurses were surveyed, revealing a knowledge deficit regarding available modalities, perceived time constraints, and a fear that J-tip use would decrease vascular cannulation success rates as major barriers. Process changes included stocking J-Tip applicator syringes in IV carts as a prompter for nurses who were setting up their trays.

A robust educational campaign included posters hung in clinical areas for quick reference, presentations at nursing forums sharing “pro tips” and disseminating metrics via the monthly nursing newsletter to celebrate successes. Target goals were exceeded with a 58 percent increase in usage for eligible patients.