Q Exchange
ProJect B+:Reducing blood testing related distress in children.
- Winning idea
- 2022
Meet the team
Also:
- - Dr Sinead Hannan, Consultant Clinical Psychologist and Project Lead
- - Bernie McGibbon, Head of Service Paediatrics
- - Stephanie McCarragher, Lead Nurse
- - Jodie Kenny, Lead Nurse
- - Ciara McCrink, Ward Manager
- - James Fallis, Associate Psychologist
- - Blinne McGee, Associate Psychologist
- - Dr Lesley-Ann Funston, Paediatrician
- - Laura Spiers, Lead Nurse Paediatrics
- - Diana Symington, Deputy Lead Nurse
What is the challenge your project is going to address and how does it connect to the theme?
Children suffer distress daily in our hospitals due to invasive procedures and we need to change this and improve how we do things, together.
Blood tests are the most common hospital-based experience associated with distress (fear; anxiety and pain) but also necessary.
Management of distress generally targets the actual physical procedure itself and can focus mainly on the child but we also need to address the biopsychosocial component.
For children:
Children who are anxious before a procedure experience greater distress during present and future procedures.
For parents/caregiver:
Parent coping has a direct impact on child coping. A parent who is calm is better able to prepare and support their child.
For staff:
A child’s distress can affect staff wellbeing and quality of care as they go to attend to the next patient. Staff who are regulated are better able to calm a parent and in turn the child.
What does your project aim to achieve?
This project aims to improve the experience of blood tests and reduce the distressing experiences for children, parent/caregivers and healthcare staff through using digital technologies at the preparatory stage of the procedure.
By April 2023, through the provision of digital training and resources, we aim to increase child, parent and staff
– Knowledge
– skill
– coping
– confidence
and provide a more positive experience for all families attending for elective blood tests within the acute hospitals in Southern HSC Trust.
Objectives:
– Empower children and parents/caregivers to be key members of their own healthcare in learning skills to self-management and cope with the challenge of having a blood test.
– Increase staff knowledge and confidence in managing blood tests and addressing own well-being needs.
– Reduce health inequalities by ensuring all families have access to supports for home-based preparation, hospital environmental resources and trained and regulated healthcare staff for all elective blood procedures.
How will the project be delivered?
Since 2021 a Paediatric Procedural Distress QI project jointly led by Nursing; Paediatric Psychology; Paediatrics; ID CAMHS and Quality Improvement has been active.
Service user representation has been established in a Service User Focus Group format.
Steering group consensus has led to the focus on blood tests in children.
Early involvement of Information Governance team.
Work will progress through 2/4 workstreams including – education and environment preparation:
· Co-design a virtual platform with interactive information for families and training modules staff.
· Environmental assessment and implementation of resources to support a calming environment.
· Release team capacity to lead on design implementation and embed project changes.
The Model for Improvement framework used throughout the project.
MEASURES
Outcome:
– Self-report measures of distress.
– knowledge.
– skill.
– confidence.
– Stakeholder feedback.
Process:
– Identify volume accessing training.
– Self-report measures of distress.
– Staff and user experiences.
Balancing:
– Time spent on training.
Clinical risk managed through current service provision.
How is your project going to share learning?
Project milestones, successes and learning will be shared through the Q Community in the format of blogs, articles and Social Media posts.
We will also promote the project through regional and local QI forums including the Northern Ireland Regional HSCQI Website and Southern Trust QI annual events.
We will also take opportunities to share findings through professionals’ forums;
– Community Nursing Governance Forum.
– Paediatrics Department Meeting.
– Paediatric Psychology Network winter webinars 2023.
– European Paediatric Psychology Conference 2023.
– We will also submit findings for publication in BMJ Open Quality.
Resources will be made accessible to other services and to all Q Community members.
How you can contribute
- Has anyone implemented any similar projects and willing to share their learning, experiences and pitfalls to avoid?
- Are there experts in the filed of web and app based education to support us or signpost us to already available resources while we develop our solution?
- We would be happy for experts in reducing Procedural Distress to join us on our team to progress our work effectively.
- If anyone has further knowledge and experience of implementing digital solutions in Northern Ireland, we would welcome your learning.
Plan timeline
| 4 Jul 2021 | Project board established in the Southern HSC Trust. |
|---|---|
| 1 Aug 2021 | Literature review completed. |
| 5 Sep 2021 | Clinical observation baseline data collected. |
| 7 Nov 2021 | Initial self-report baseline data collected. |
| 6 Feb 2022 | Service Users identified and contacted to incorporate coproduction of project. |
| 1 Mar 2022 | Training and environmental support sub-streams established (including service users). |
| 10 Apr 2022 | Initiate Data Protection Impact Assessment with Information Governance. |
| 17 Apr 2022 | Development of Information and Training content. |
| 8 May 2022 | Service User co-design forum to be formed (young people). |
| 5 Jun 2022 | Initiate Environmental assessment. |
| 3 Jul 2022 | Implementation of environmental changes in stages (PDSA cycles). |
| 3 Jul 2022 | Tendering request for digital companies. |
| 7 Aug 2022 | Contract Digital company. |
| 11 Sep 2022 | Development of digital platform (prototype to full build). |
| 4 Dec 2022 | Pilot Digital platform (PDSA cycles). |
| 7 May 2023 | Share and spread! |
Project updates
17 Jan 2023
Hi Everyone.
We have had a very busy few months progressing through:
- service user and staff engagements
- developing and refining our initial plan to improve our young people’s experience of undergoing blood sampling.
- Implementing first stage PDSA cycles in how VR headsets might reduce anxiety, perception of pain and confidence in relation to getting bloods taken.
We have also been sharing our experiences across social media and creating new working relationships with other key stakeholders across Northern Ireland and the UK as a whole. See below for one Twitter story:
#Qexchange funding winners Project B+ documenting the progress of their first #PDSAcycles. Testing the use of VR headsets to reduce paediatric procedural distress. Exciting to see really positive experiences. @theQCommunity @jmortonQI @Sinead_Hannan_ @SouthernHSCT @HSCQI pic.twitter.com/YH0G6xBf1s
— Ronan mcBride (@mcBrideRonan) November 2, 2022
Also attached is an update presentation for your convenience, showing some of our initial data.Q Exchange Update Jan 2023 final
Thanks to everyone who has supported us and is continuing to do so. Thanks again to the Q Community for the Q Exchange funding. Without it we wouldn’t be making positive impacts on young people’s hospital experiences.
Comments
Chris Evans 4 Jul 2022
Hi Ronan,
We've developed a resource called Little Journey that prepares children and their parents before a blood test in their own home. The app can be tailored to the local hospital environments so children can see the exact rooms they'll visit on the day. It then has distraction games for use during the procedure. The app can be used in VR too. We're just started working with LEGO foundation and National Association for Special Education Needs to see how we can tailor the solution to children with Autism/ADHD and support them in making plans and reflecting. Would be great to connect.
Chris
Ronan McBride 5 Jul 2022
Hi Chris.
Thanks again for your post. Someone in the team will definitely be in touch for a chat about your work. Little Journey looks great!
Ronan
Julie Smee 4 May 2022
I have a daughter who has various disabilities and autism and blood tests create great anxiety for her. What really worked for her was access to a play worker to do role play in advance and to be there at the time of the blood test to distract. Have you considered children with disabilities as part of this work?
Ronan McBride 5 May 2022
Hi Julie.
Thanks for commenting and for raising the need to consider children with disabilities, and their families.
We have ID CAMHS Health Professional representation on the steering group. Children with disabilities and their carers will also be part of the design and ongoing development of the project, including the development of resources and the design of the environment. We will build in the unique needs of children with disabilities and ASD with great focus on communication and sensory needs.
Also as part of ongoing project development we will gather real life stories of the experiences of having blood tests and this will feed into the training packages for health professionals.
We will bring your support worker and role play suggestion back to the team and make sure your voice is heard.
I hope this answers your query. Thanks again for taking the time to post.
Ronan
Grace Cuddy 19 Mar 2022
This is fantastic. Have you been in touch with RBHSC MRI dept to ask how they implemented their VR etc? There was also a lot of conversation about this type of thing last year at the Child Health Technology Conference with VR for physio. If there's anything I can help with let me know, although I'm only definitely in CAH until the end of July.
Thanks
Grace
Ronan McBride 21 Mar 2022
Also to add Grace, we have been in touch with Cormac McGrath in Belfast trust MRI over the last few months as we are completing a seperate QI improvement project with Southern Trust MRI Dept and Paediatrics which is building on the Procedural Distress work that we are hoping to undertake through the Q Exchange.
There really is lots happening!
Ronan McBride 21 Mar 2022
Grace, this is a great recommendation. We will get on to the team at the RBHSC MRI department and see what we can learn from them.
Thanks for commenting. Feel free to get in touch if you are working within the Trust and we can learn more from you!
Best wishes, Ronan
Hazel Neale 18 Mar 2022
Great to see this work progressing following on from the Literature search I supported last year. This is a valuable project that will enhance care going forward, I have a personal investment as I was that parent giving support during blood tests so anything that helps remove the distress will be great. Best wishes for this project.
Ronan McBride 21 Mar 2022
Thanks Hazel.
Kind words and thanks for supporting the initial Literature trawl. I know it wont be the last!
Kind regards, Ronan
Ronan McBride 16 Mar 2022
UPDATE:
Following ongoing project preparation we have identified a parent who has joined the core steering group to support the work from a service user / carer perspective.
Our focus is very much on co-design and we are actively engaged with our young people using the service to help us design an effective solution.
Kate Pryde 16 Mar 2022
As others have commented an important and often neglected area. HAve you looked at work being done by otehr sites and external companies - lots of companies offering virtual tools and some really fancy including V
R etc. THese are expensive - making sure somehting is shareable and accessible to wider NHS without large sums of money would be great
Ronan McBride 16 Mar 2022
Hi Kate.
You have nailed it. Some approaches to dealing with phobias and procedural distress are there but can be really expensive. The wider team have and are continually scoping available solutions which might be more cost effective for our Trust in the long run. The use of VR is something that our clinical lead Dr Hannan is keen to try and we all feel this might be a valuable tool for our young people.
Thanks for commenting and best of luck on your own application.
Lynsey Lucas 16 Mar 2022
As a Practice nurse in the local area, I often have blood monitoring to perform on children on DMARD medication etc. This service sounds like an excellent idea and I look forward to hearing more. I witness the stress not only on small children, but also their caregivers.
Ronan McBride 16 Mar 2022
Thanks Lynsey. Many of us have seen the challenges first hand, much like yourself. We really hope we can make a hugely positive impact through this project and we will be sharing the learning (what worked and what didn't!) through the community and also through wider professional fora. We hope to get the message back to clinicians such as yourself to help you make life better for our young people.
Thanks for your comment!
Helen Fitzpatrick 15 Mar 2022
This is a great and necessary initiative. It has surprised me since taking bloods for various clinics what a complicated role a phlebotomist has. Even tools that we have to comfort one child may actually distress another. The children's diabetic clinic has so many children that are afraid of the 'big bloods' yet cope with finger pricks every day. This will surely produce some very important research. Good luck.
Ronan McBride 16 Mar 2022
Helen, we hope it will produce a wealth of information for wider dissemination. Not just what has worked, but just as importantly, what hasn't worked!
Thanks for taking the time to comment.
Claire Cumiskey 15 Mar 2022
This is a brilliant idea! Phlebotomy is an essential part of paediatric care however this common procedure often doesn't get the respect it deserves in how it can shape the overall positive or negative outcome of a medical contact for a child and their family which can stay with them for a long time and ultimately impact on future attendances.
I'd previously created a leaflet to help parents prepare their child for a blood test which was very well received but in this increasing digital age I think an interactive/ online version will make it far more accessible and engaging for the child & family.
Ronan McBride 15 Mar 2022
Hi Claire,
thanks for commenting. If you are interested in sharing your learning for the work you have done, we would love to hear about your experiences. I'll make a connection with you and we can chat about this more!
Many thanks,
Ronan
David Grier 14 Mar 2022
This is an excellent idea to reduce the stress that children and caregivers have when attending for this common procedure which can be frightening for children of all ages.
I will be delighted to help in any way that you feel that I can.
Ronan McBride 15 Mar 2022
Hi David. Thanks for taking the time to comment and like. It would be great to have your experience as part of the ongoing work in the Trust!
Best sishes,
Ronan
Debbie Bell 14 Mar 2022
Great project, we have a lot of young people in CAMHS that have phobias and we struggle to get them to engage with blood tests. I believe that this will reduce their anxiety and stress. It is important that we provide them with a safe, contained and calm environment. Good luck!
Thanks
Debbie Bell CAMHS Manager
Ronan McBride 15 Mar 2022
Hi Debbie,
Yes, we feel the same. The team as a whole really hopes to make a very positive impact for all our children and young people that use our service. The phobias are hugely impactful on how we do our jobs and how our young people experience our service. I hope you'll vote for us when the time comes!
Thanks for your comment.
Ronan
Danielle Leemon 14 Mar 2022
This is a really exciting and much needed project. Looking forward to it's implementation and helping in any way I can!
Ronan McBride 15 Mar 2022
HI Danielle,
thanks for your comment. I hope we can count on your vote when the time comes!
Best wishes,
Ronan
Dr Phil Quinn 14 Mar 2022
This is an excellent idea that gives promise to benefit children, parents and staff using ideas and resources that almost certainly exist but have yet to be collated and utilized efficiently. In our experience as parents and clinicians we do indeed recognize how our own behaviour and attitude can positively or negatively effect the children we deal with: positive empowerment to calm and dissipate stress around procedures is an excellent initiative to be supported. Thank you to the team for leading in this area.
Ronan McBride 15 Mar 2022
Very true Dr Quinn. There are lots of resources out there. We hope to draw on some of the best digital approaches to really benefit our young people. All suggestions, help and support are welcome.
Many thanks for your comment.
Ronan
Laura Spiers 14 Mar 2022
Looking forward to the development of this fantastic project which has so much potential to make such positive changes to the way children and young people are prepared for venipuncture.
Ronan McBride 15 Mar 2022
Yes Laura. We will be able to work together to see this come to fruition. It's an exciting time for the team as a whole!
Ronan
Julianne Lee 11 Mar 2022
This is a great idea and could be used not only for children having elective blood tests in the hospital setting but also those having bloods taken in community clinics.
Wishing you all the best with your project and looking forward to hearing how it progresses.
Ronan McBride 15 Mar 2022
Thanks Julieanne! I hope we can count on your vote going forward.
Best wishes,
Ronan
Sam Thompson 10 Mar 2022
Great initiative, many thanks to everyone involved.
Ronan McBride 15 Mar 2022
Thanks Sam!
David Graham 9 Mar 2022
This is an excellent initiative that is long overdue. I understand there is a wealth of evidence to show the benefits of improving in this area. By reducing the distress/ anxiety & trauma of procedural pain we can really improve longer term outcomes for these children (needle phobias/ health care anxiety).
There are good examples of this work taking place already in other parts of the world. I am excited that the team in the Southern trust are leading the way in this and I envisage the changes spreading throughout NI.
I would be really keen to help in any way I can also - thank you.
Ronan McBride 10 Mar 2022
Hi David.
Thank you for taking the time to comment.
Yes, there is quite a bit of evidence available supporting the need for this work which the core team have used to evidence the need for this work: needle phobia and taking bloods are just a small aspect of procedural distress though the project team feels this is a great starting point to build a replicable and innovative solution.
Thank you also for showing your interest. If successful with the application we can get in touch.
Best wishes,
Ronan
Linzi hughes 9 Mar 2022
This looks like a great much needed project. Preparing children is key to make it a positive experience.
Ronan McBride 9 Mar 2022
Hi Linzi.
Thanks for reading, and for your comment. We feel the same. We welcome any thoughts you might have on how we can change or improve our proposal.
Many thanks.
Rebecca Todd 9 Mar 2022
This is a great initiative to bring forward. We encounter children requiring this procedure on a daily basis and I strongly believe this will benefit their experience with us!
Ronan McBride 9 Mar 2022
Hi Rebecca,
thanks for your comment. We in the project team feel the same. It is something so simple yet potentially so impactful for the lives of those children who suffer needlessly with the stress of coming to hospital. We really want to make a difference.
Diana Symington 9 Mar 2022
This is a very exciting project, looking forward to seeing the outcomes in the near future.
Ronan McBride 9 Mar 2022
Yes Diana. We will be setting clear measurables throughout the process and are confident that we can make a positive impact that can be shared!
Bernie McGibbon 8 Mar 2022
Looking forward to working with colleagues to improve the experience and positive outcomes for and with children, young people and their parents/carers attending for blood test procedures with a view to extending to other distressful procedural areas in the future.
Ronan McBride 9 Mar 2022
Bernie, there is so much potential to this project. I am excited myself to see where it can go and the positive impact we all can make on our children using the services.
Una Hughes 8 Mar 2022
This looks like a great idea with potential for expansion to other stressful experiences for children. I look forward to seeing your progress and perhaps we can share information about Web and app based solutions.
Good luck
Una
Ronan McBride 9 Mar 2022
Yes Una. The focus on blood testing really is only one aspect of a larger problem. We welcome any and all collaboration that helps drive our services forward to a place where we can improve the experiences that our children service users are having, and YES it definitely is something that can be developed further for other distressful procedures - that is the end goal!
Thanks for taking the time to comment.
Jacqueline Morton 7 Mar 2022
The Quality Improvement Team are really keen to support you on your QI Journey.
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