Donna Eull, RN, MA, CHPN
For our winter newsletter, Focus on Education, we are fortunate to offer an interview with Donna Eull, RN, MA, CHPN. Donna is a pain and palliative care nurse at Children’s Hospitals and Clinics of Minnesota, where she has been instrumental in staff education and implementation of the Children’s Comfort Promise for children and their families.
The Children’s Comfort Promise is an organization-wide initiative to prevent and treat needle pain and anxiety. The Comfort Promise involves consistently offering a bundle of 4 options that children and families can choose from:
- Topical anesthetic
- Comfort positioning
- Sucrose or breastfeeding for children under 12 months of age
The project team has developed videos and handouts for children/families and staff caregivers introducing the concepts, describing specific techniques and interventions, and providing additional resources.
The project officially began back in 2013, when caregivers from the pain, palliative care, and procedural sedation disciplines were dismayed by lack of a system-wide approach to preventing and managing pain associated with “minor” procedures such as venipuncture, despite having excellent pain management processes for trauma and more invasive procedures. A survey of all non-NICU inpatients performed on a single day that year at Children’s revealed that the single greatest source of pain and anxiety for children and families was needle procedures including venipunctures, IV starts, and injections (1). Interestingly, bedside staff surveys performed at the same time revealed that staff felt their current pain management strategies were very successful and that it was more important to be “fast and accurate” than to focus on comfort (2-3). Based on that discrepancy, Donna, Dr. Stefan Friedrichsdorf, and others from the pain and palliative care service advocated with hospital leadership to support an organization-wide project to provide best practice care for reducing needle pain in children. The Lean “Value Stream” system served as the methodologic framework for the initiative, and Donna has served as a full-time clinical resource nurse and as the Value Stream manager throughout the now 5 year development, implementation, and continuation process. A full text article summarizing the Children’s Comfort Promise journey can be found at:
Our questions and Donna’s replies:
How do you motivate staff to get interested in a project like this that involves a lot of change?
“Everyone who works at Children’s is passionate about caring for kids so I shamelessly leveraged that. These 4 simple strategies are game-changers for kids and create a much better patient experience. I used that to motivate staff.”
What have been the most effective ways to engage staff during this process?
“Hearing their concerns before we started and having front-line staff from each area work on solutions for their unit. Every unit has their own culture, workflow, and special issues. We never told units how to get this done – we showed them where they were and where they needed to be and asked them to tell us how they were going to get there. Of course, we thought through every possible scenario ahead of time and had solutions planned and ready, but most of the time the work teams from the unit came up with the same solutions on their own. We also had them report out the new plan to their units, so it came from someone known and respected within the unit.”
Once folks have embraced the project, how do you keep them energized to maintain their success?
“Once people try using the new strategies, the results they see in their patients are all the motivation needed. It really makes a huge difference, and also ends up being a time saver, which makes total sense as a calm cooperative child is much easier to access than a frightened, combative child.”
The Children’s Comfort Promise is great for kids, but it must have involved a significant organizational commitment of time, resources, and finances to develop, implement, and maintain. What strategies proved most successful to obtain hospital administration support for this project?
“We were lucky to have great executive support from our CNO, CMO, and COO. Seeing the improvement in patient satisfaction scores was a great reinforcement. Typically everyone was happy if our NCR Picker pain satisfaction scores improved by 1% a year. In the initial 2 years of inpatient implementation (Q3 2014- Q3 2016), we had a 10% and 12% improvement in our 2 pain questions! The first 3 years we had 0.5 FTEs of support from Lean, but lost that in year 4. My 1.0 FTE also includes providing education to all new hires on pain and palliative care, as well as ensuring that Joint Commission standards are met for pain, reviewing and updating all related policies and procedures, and supporting a multi-site grant from the MayDay Fund to disseminate the Comfort Promise to 4 other hospitals in North America.”
How have you all educated patients and families about the Comfort Promise?
“We worked with the Family Advisory and Youth Advisory Councils, and developed videos, website materials and patient family education materials. We included information about the Comfort Promise in all patient welcome packets, aired information on the internal TV channel, and were interviewed on the Star studio program. Word spreads quickly via the mommy network, so once we pushed it out to the clinics, word spread fast. I firmly believe families will expect this to be standard of care within the next 4 years.”
For others considering or in the process of a large, multidisciplinary, patient-focused project or intervention, what key suggestions would you have for them to maximize success?
“Engage leadership to ensure support and make sure opting out is not an option. Then make sure front-line staff are involved in creating the process. Make sure you pay attention to logistics – where are things kept, who supplies, who cleans? You want to make it easier for staff to do it the new way, so it has to be available and close every time they need it. Have someone who has dedicated time available to teach and provide hands on assistance for application of numbing, positioning, and distraction techniques.”
Want to learn more about the Comfort Promise for your sedation program and beyond? Donna will be co-presenting a workshop titled, “Using the Comfort Promise in your procedural sedation unit,” along with Jean Solodiuk RN, PhD, from Boston Children’s at the 2019 SPS conference in Denver on Monday, May 20th. Donna will also be leading a PBLD on the same topic on Tuesday morning. Hope to see you there!
- Friedrichsdorf SJ, Postier A, Eull D, Weidner C, Foster L, Gilbert M, Campbell F. Pain outcomes in a US Children’s hospital: a prospective cross-sectional survey. Hosp Pediatr 2015; 5:18-26.
- Friedrichsdorf SJ, Eull D, Weidner C. A Children’s Comfort Promise: how can we do everything possible to prevent and treat pain in children using quality improvement strategies? Pediatr Pain Letter 2016; 18:26-30.
- Friedrichsdorf SJ, Eull D, Weidner C, Postier A. A hospital-wide initiative to eliminate or reduce needle pain in children using lean methodology. Pain Reports 2018; 3:e671.