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Introduction
Immunizations given by injection are painful. The experience of having a painful injection can cause a life-long fear of needles, which can lead to potential avoidance of health care, including vaccine hesitancy (Taddio et al., 2015). There are techniques that can be implemented by health care providers to minimize pain during injections. However, these techniques are underutilized. Therefore, improving pain management during vaccinations is an opportunity for improvement in the quality of care delivered to children (Taddio and Rogers, 2015).
In Ontario, Canada, immunizations begin at two months of age and continue throughout infancy, childhood and adolescence. In Ontario, a toddler will receive ten injectable immunizations by 18 months of age (MOHLTC, 2016). Clinical practice guidelines to reduce vaccine injection pain are available. However, there is low uptake of pain mitigation interventions in clinical practice resulting in potentially unnecessary pain and suffering (Chambers et al., 2009; Taddio et al., 2015).
The North Bay Nurse Practitioner-Led Clinic (NBNPLC) is one of the 25 NPLCs providing comprehensive primary care to people of all ages in Ontario. The clinic is staffed by a multidisciplinary team of four nurse practitioners (NP), a registered nurse, a registered practical nurse, a registered dietitian, a social worker, a physician and a pharmacist. In 2012, the NBNPLC partnered with the Registered Nurses Association of Ontario (RNAO), with funding from the Ministry of Health and Long Term Care to become a Best Practice Spotlight Organization (BPSO) over a three-year period of time.
The NBNPLC committed to implement the Assessment and Management of Pain Best Practice Guideline (RNAO, 2013) into their primary care practice. An identified area for improvement was assessment and management of pediatric pain during vaccinations. Routine assessment of pain utilizing a standardized tool is recommended prior to, during and after painful procedures. Assessment tools must be reliable, valid and feasible for use in practice (RNAO, 2013). Clinical practice guidelines describe how to mitigate pain during vaccinations according to age. The five Ps of pain management that can be used with children during vaccinations or other painful procedures are: psychological techniques such as honest, neutral communication and distraction; procedural techniques before and during vaccination, such as no aspiration (drawing back on tissue prior to injecting); process strategies such as...