Background:Combining coping strategies can help reduce children’s pain and distress during needle procedures in the emergency department (ED).
Objective:To evaluate the use of strategies to reduce procedural pain/distress for children in the pediatric ED, with the implementation of an institutional quality improvement (QI) initiative working with a Certified Child Life Specialist (CCLS).
Method:The QI initiative Tout doux aims to alleviate procedural pain/distress. To evaluate the impact of this project on the use of coping strategies during needle procedures in the ED, CCLS interventions were recorded over a one-year period. The number of strategies used during needle procedures was reported to track progress monthly throughout the integration of the QI initiative Tout doux.
Results:Between Sept 2021-Aug 2022, the CCLS was present for 397 needle procedures (Mean age: 6yo [0months-17yo]). Procedures included 56% IV-line insertions, 30% venous blood draws and 14% capillary blood tests. Parents were present at 99% of procedures. Preparation strategies were used in 65%, distraction in 98% and deep breathing in 46%. Topical anesthetic was offered for 37% of procedures. The proportion of children receiving at least 3 strategies alleviating procedural pain/distress increased to more than 90% during the last 7 months (except one very busy month) in comparison to 22%-66% for the first 5 months with the implementation of the QI initiative Tout doux. 
Conclusion:The QI initiative Tout doux increased the use of combined coping strategies with the help of a CCLS. Further studies will need to evaluate impact on patients and the sustainability of their use.