Project SMILE: improving pediatric residents’ use of tools to minimize procedural pain

Background. In medical settings, children are subject to many painful procedures. Pain management during procedures not only reduces psychological and physical trauma but also impacts children’s future responses to pain and procedures. This project aimed to create sustained change in the residents’ culture surrounding procedural pain management in pediatric patients. We hypothesized that an initiative involving education, reminders, and multidisciplinary integration would increase the amount of pain reduction methods used during painful procedures. Methods. The initiative included all pediatric residents at a single healthcare institution in the northeastern United States, where the pediatric population is only a fraction of the patient load. Project S.M.I.L.E. utilized a novel acronym that incorporates different pain-minimizing techniques to encourage the use of these techniques through educational initiatives, multidisciplinary participation, and increased access to resources. Surveys were conducted pre- and post-intervention to determine the level of change in procedural pain levels. Results. A total of 24 pediatric residents participated in the survey. The baseline evaluation included 20 procedures, including intravenous line placements, venipunctures/heel sticks, and arterial punctures. Two years after the onset of this initiative, surveyed pediatric residents showed a sustained increase in their use of these methods. Conclusion. This project demonstrates that the low-cost and simple methods employed in this initiative are efficacious and can be adapted for use in other programs.