Last month we got curious about pain and anxiety. Researchers are reporting a dramatic increase in the number of needle-phobic patients and those who express significant anxiety about needles in healthcare. So we asked our subscribers and visitors to our web site what they are using to reduce the pain and anxiety of phlebotomy on pediatric and adult patients. 

For pediatrics, over 70 percent of those responding said they use verbal distraction (conversing, small talk, etc,)(85%), parental comforting (81%), use of a 23-gauge needle or smaller (79%), and visual distraction (71%). If survey participants had to choose only one technique from our list of 13 strategies, verbal distraction received the most votes (27%).

For adults, 91 percent said they used verbal distraction making it the most popular strategy in our survey. Explaining the procedure in advance is used by 64 percent of respondents, while visual distraction is used by 51 percent. The single most preferred technique for reducing anxiety on adults is verbal distraction, preferred by 72 percent of those who responded.

Other strategies offered by those responding include:

• "having patients count in multiples of three"
• "Getting it done quickly & efficiently"
• "relaxation techniques,"
• "being personable and getting the venipuncture over with as quickly and efficiently as possible"
• "There is nothing better than being calm and soothing to any patient. Never tell them it doesn't hurt, of course with infants that's different."

Seventy-two percent of respondents said the frequency of patients with needle fear has not changed much since they entered healthcare.

Comments include:

• More adults are admitting their fear. Some insist on butterfly [needles], which, in reality, ARE NOT needed.
• Parent's behavior and demeanor seem to feed an already anxious kid. I think it is a learned behavior.
• We need to demand more training and higher standards for phlebotomists!
• Allowing young patients to watch what is happening if they would like to often reduces their anxiety quite a bit if they can see what is happening.
• We have just introduced Skin to Skin for newborns.at our hospital.
• Having everything prepared and ready to go before entering the room. Delay while I get set up adds to anxiety. 
• Our local Children's Hospital uses Pain Eaze; local NICU units use Sweet-Eaze
• Suggesting to medical assistants to inform parent to purchase the topical anesthetic, and apply topical & cover with clear medical tape 30 mins before blood draw!
• I despise using topical anesthetics and ice as they just don't seem to work.
• Have inflated gloves like a balloon.
• Have child sing.
• We use Buzzy, small talk, games, age appropriate search-and-finds, singing, having the nurse dip the pacifier in sucrose, bubbles, tablets with videos & games, comfort positioning, training with specialised (sic) child-life in-services, and we have a child life specialist on-call for outpatient and impatient collections at all times.
  

Next month's survey asks about your productivity. How many patients do you typically draw per hour? Does your employer have an expectation about how many you should be able to draw per hour or per shift (i.e., a quota)? Take the survey.