Living our ‘caring’ core value: Phlebotomists focus on comfort to ease patient anxiety

October 20, 2020  //  FOUND IN: Our Employees,

Having blood drawn, or what people call a “needle poke,” is one of the most common procedures in the hospital — and yet, for many, it can be the most terrifying medical experience they encounter. This is why a multidisciplinary team of researchers and front-line phlebotomists conducted a research project and designed a “poke program” to reduce the anxiety and pain associated with pediatric blood draws.

“I must have been told by parents over a thousand times that their child was more afraid of the blood draw then they were of major surgery, and I witnessed it myself as I helped prepare children for surgery,” said Julie Piazza, M.S., CCLS, a certified child life specialist and project manager in the Office of Patient Experience. “We had gaps in our training and knowledge about how to make this experience more comfortable for a child. It was a barrier to the work.”

Piazza said many who performed blood draws knew “quick fixes,” such as comfort holds, distractions and words of explanation, but those weren’t being applied consistently. So the project team carried out surveys, clinical observations and tested new practices in real time. The end result was a tool box of comfort techniques previously missing in phlebotomy training.

‘A voice and a choice’

For Amy Ohmer, the parent of two daughters with Type 1 Diabetes (T1D), an autoimmune disease which requires daily insulin injections, the most important part of the project was that it gave the patients and parents “a voice and a choice.”

“To have the phlebotomists trained in comfort skills was wonderful, but most importantly it was about having an individualized poke plan in place,” said Ohmer, who experienced the project first-hand as a member of the Mott Patient/Family Advisory Council. Her daughters also provided feedback through the Teen Advisory Council.

When her children were first diagnosed, there were no structured plans to handle regular blood draws.  “As a parent, it was stressful sharing my daughter’s needs because the clinic wanted to hurry up and get the procedure done. I often left after the procedures with tearful children,” she said.

Through the new program, an individualized poke plan is developed for each patient and referred to at each blood draw, injection or clinic/hospital visit. 

“A poke plan shares what helps the kids feel best, and helps the medical team understand that for a child, there is no ‘getting used’ to injections,” Ohmer said. “A poke is a poke and it hurts no matter how many times you have had one.”

Ohmer’s 19-year-old daughter, Reece, who was diagnosed with diabetes at age eight, agreed.

“When I was little, I was always fearful because no one ever told you what was going on. I wanted to be involved in this program so that I could make other kids’ experiences better than mine was. Having a poke program for kids can help relieve the fear and worry.”

Adults carry painful memories

Anxiety over needle pokes not only effect children, but adults as well. Research shows that stress over blood draws early in life can lead to long-term anxiety, which sometimes causes adults to base important decisions about surgeries or medical treatments on these fears. 

No one knows this better than Brooke Rothberg, who almost didn’t follow her dream based on that fear.

“I was that kid who would crawl behind an exam table or lock myself in the bathroom because I was so petrified of vaccines,” Rothberg said. “Based on my childhood fear of needles, becoming a doctor was nowhere on my list of possible careers, even though I did well in the sciences. But then I enrolled in a chemistry course at U-M and realized I wanted to be pre-med.” 

After being taunted by her brothers, she decided she “needed evidence” that she was over her childhood fears and joined the Poke Program as a research assistant as an undergraduate at U-M.

“I was inspired and motivated to humanize the blood draw experience. This project has helped me personally and I believe it can really make a difference. After seeing the effect of distraction or comfort words, I hope this message can be integrated in all fields of medicine,” said Rothberg, who is now a third year medical student at Florida Atlantic University.

Building trust and care 

According to Jennifer Slater, manager of on-site phlebotomy services, this project has helped phlebotomists become more confident in their comforting skills and has built a broader awareness for the complexity of care required for pediatric patients.

“I am immensely proud of our phlebotomy teams,” she said. “Often our team members are establishing trust and confidence with the patient and/or family member in just minutes while performing an invasive procedure. They are an essential component to quality patient care and their expertise in specimen collection makes a difference.”

“We have real interests in our patients’ care and often become close to parents and patients,” said Annie Rosin, supervisor of the Mott phlebotomy team.  “Our hearts are wrapped up in this job.”

Since the project began, the team provided toolkits throughout Mott, and they hope to continue to share their findings nationally, as well as expand the program to adults. In addition, the research prompted the hiring of a child life specialist dedicated to the C&W blood draw team. The team has also reached out to the community through distance learning programs and family events at the Ann Arbor Hands-On Museum and virtually. More information can be found here.

“This is a true example of people coming together and showing we care,” said Piazza. “We knew there was a gap and we needed to find a way to support one another in learning to solve it together. We gave the frontline the tools to treat people with dignity, respect and compassion.”

Every month, Headlines will be highlighting one of the organization’s core values. This month is caring. Do you have a story that demonstrates caring at Michigan Medicine? If so, send to headlines@med.umich.edu and it could be featured in an upcoming edition of the newsletter!

Learn even more about the poke program by listening to The Wrap via the YouTube video below or the audio-only version at this link.

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