Authors: (including presenting author): :
Tsang WSJ (1), Wong KSJ (1)
Affiliation: :
(1) CUHK Medical Center, Emergency Medical Center
Keyword 3: :
Intramuscular Injection
Keyword 5: :
painful procedure
Introduction: :
Intramuscular (IM) injections are frequent procedures in Accident and Emergency Departments (AEDs) that often cause significant anxiety and pain, potentially leading to needle fear and care avoidance (McMurtry et al., 2015). While the concept of a "Painless AED" is a strategic ideal for patient-centered care, time constraints in acute settings often hinder the use of traditional topical anesthetics. To bridge this gap and initiate a cultural shift toward routine procedural pain management, this project introduced a rapid, non-pharmacological intervention grounded in gate control theory (Melzack, 1978). This initiative serves as the foundational step in promoting a comprehensive "Painless AED" environment.
Objectives: :
The primary objective was to evaluate the effectiveness of combined vibration and cold-induced analgesia in reducing pain intensity and improving satisfaction among patients aged 3 years and older receiving IM injections. Furthermore, the project aimed to assess staff acceptance and workflow feasibility to determine the potential for expanding this pain-reduction model to other painful procedures within the department.
Methodology: :
Guided by the Johns Hopkins Evidence-Based Practice Model (Dang & Dearholt, 2017), this initiative was implemented in a private AED from May to August. The protocol utilized a device (Buzzy®) delivering simultaneous vibration and cold, applied 30 seconds prior to and during the injection. Data were collected from 280 patients using age-appropriate pain scales (Numeric Rating Scale or Wong-Baker FACES) and satisfaction surveys. Staff perceptions (n=15) regarding efficacy, confidence, and integration were evaluated via post-implementation surveys.
Result & Outcome: :
The initiative achieved a statistically significant reduction in mean pain scores (4.54 prior vs. 2.53 intervention, p< .001). However, the most significant indicators of success regarding the "Painless AED" concept were patient and staff engagement. Patient satisfaction was high, with 86% of participants indicating they would choose the combined therapy again. Notably, the intervention created a demand-pull effect; patients who experienced the therapy once began actively requesting the device for subsequent injections, validating its impact on their care experience. Staff feedback strongly supported the initiative’s viability. Survey results showed that 87% of nurses rated the intervention as effective in reducing pain, and 93% reported high confidence in operating the device. Despite the fast-paced AED environment, 67% of staff found the device easy to integrate into their workflow, and 67% expressed a strong intention to continue its use. These results confirm that combined vibration and cold therapy is a feasible, high-satisfaction solution that empowers staff to deliver a "Painless AED" experience.
