38 Key to Success to Improve Best Practices: A Nurse Champion to Increase Institutional Use of Procedural Pain and Distress Management Strategies

Abstract Background Procedural pain and distress management are essential when providing medical care to children. Quality improvement (QI) initiatives need to be developed to improve the knowledge of healthcare providers (HCP), increase their adhesion, and improve care. The Tout doux project is an institutional QI initiative aimed at improving procedural pain management. Since studies have shown that nurse champions are facilitators in implementing best practices, a procedural pain nurse champion (PPNC) was a key part of the Tout doux QI initiative. Objectives The aim of this project is to assist HCP in the reduction of children’s procedural pain and distress by increasing their use of procedural pain and distress management strategies with the support of a PPNC. Design/Methods For each sector, the PPNC organizes meetings with medical/nursing heads to coordinate and adapt local deployment and helps create a local, multidisciplinary Tout doux committee. Afterward, the PPNC collects data through audits of different procedures, on every shift, to assess the baseline use of pain management strategies. Those results are presented to the local pain committee to determine improvement needs. Then, HCP receive mandatory training through an e-learning module or official lectures to strengthen their knowledge and discuss barriers based on the traditional “4P” approaches to reducing procedural pain: Prevention, Psychological, Physical, and Pharmacological strategies. For 2 months, the PPNC gives field support to the team by providing direct coaching during procedures, helping to guide the local Tout doux committee, and consolidating new HCP knowledge into practice. After this period, audits are completed to evaluate these combined strategies. Results Between June 2021 and October 2022, the Tout doux project was deployed in 13 sectors. More than 400 audits were conducted pre-deployment. To date, more than 150-post deployment audits have been realized in 6 sectors. Results show improvement in the use of combined procedural pain and distress management strategies: from 160/234 (68%) of procedures using two or more strategies before the deployment, to 132/150 (89%) of procedures post-deployment (Table 1). To this day, more than 1500 HCP have received training throughout CHUSJ units and clinics. Conclusion Deploying the Tout doux project on procedural pain and distress management improved the combined use of coping strategies with the support of a dedicated PPNC. The next step will be to ensure its dissemination throughout the institution and further assess the long-term outcome on patients.