Implementing the CARD System Distraction Techniques in Pediatric Primary Care – A Practice Improvement Project

Problem: Increasing vaccine uptake is an urgent priority in public health. Often pain and fear are reasons for vaccine refusal, leading to lower vaccine uptake. The Comfort, Ask, Relax, Distract (CARD) system was developed to improve the vaccination experience and has been successfully implemented in school-based vaccination clinics and community pharmacies. The clinic that served as the site of this practice improvement project was routinely using 3 of the 4 CARD techniques (Comfort, Ask, and Relax), but was not offering evidence-based distraction methods to patients eligible for vaccination. Approach: This practice examined the feasibility and acceptability of implementing CARD distraction methods into the clinical workflow of a pediatric primary care setting. For a 90-day period between September and December 2024, distraction methods were offered to eligible patients who accepted vaccines at their appointment. Also, data were collected from the electronic health record, including the percentage of eligible patients who were offered distraction techniques, who accepted distraction methods, and who were actively engaged with the distraction methods just before vaccine administration. Outcomes: Of the 58 patients who accepted vaccines during their visit, 32 (55.2%) were offered CARD distraction techniques by the provider. There was 100% caregiver acceptance among patients who were offered the distraction techniques. Before their vaccine administration, 30 of 32 (93.8%) children were engaged with CARD distraction methods. Next Steps: This project showed that CARD can be integrated into pediatric primary care. Further research is needed to assess equity in offering distraction techniques and how CARD influences patients’ perceived pain and fear during vaccine administration.