P2.290: Reducing Vaccine-Related Pain with Comfort Promise; A Resident-Led QI Project

Purpose/Objectives: The Comfort Promise (CP) program is an evidence-based approach to reducing injection-related pain and fear in pediatric patients through six key interventions: numbing cream, comfort positioning, distractions, choices, breastfeeding or sugar water, and memory-shaping. While well-studied in inpatient settings, CP’s use in outpatient environments remains less explored. In 2023, 63% (9,600/15,095) of visits in our general pediatric clinic included vaccine administration, yet no formal pain-reduction strategies had been implemented. To address this gap, we piloted CP in our academic primary care clinic as a part of a Phoenix Children’s initiative to reduce injection-related pain and mitigate future needle phobia.

Our aim is to decrease injection-associated pain in outpatient primary care. Our primary SMART aim is to implement CP in >50% of vaccine-related provider visits by June 2025. Our secondary SMART aim is to increase the percentage of caregivers reporting pain was “definitely” addressed by 10% by May 2025.

Design/Methods: Specific measures include CP implementation frequency (process measure), caregiver-reported pain management effectiveness (outcome measure), and MA job-related stress (balancing measure). Interventions targeted key drivers (see Key Driver Diagram): patients/families, medical assistants (MAs), the electronic health record (EHR), and providers. MAs were trained on CP strategies and introduced a standardized script with an infographic for families. We assessed MA job-related stress before implementation and plan to reassess three months post-rollout. Patient satisfaction surveys now include pain control questions. Standing orders for numbing cream (LMX) and sucrose were incorporated into order sets, and the MA intake note was updated to document CP offerings. Education sessions and workflow modifications ensured consistent CP implementation.

Results: Before CP (January -December 2023), 0% of vaccine visits incorporated CP interventions. Go Live for CP was 2/11/25. Throughout February 2025, CP was offered in 78% of visits, decreasing slightly to 72% in March 2025 (see Run Chart). The most frequently selected interventions were LMX (28.6%) and Buzzy/vibration (30.5%). CP was declined in 25% of cases. Before CP (Jan 28–Feb 10, 2025), 57% of families reported patient pain was “definitely” addressed by staff. Ongoing monthly monitoring will track trends using a run chart. A pre-implementation survey found that five of seven MAs reported occasional job-related stress.

Conclusion/Discussion: Early CP pilot data suggests strong adoption and acceptance among patients, families, and medical teams. Our structured rollout established the groundwork for an institution-wide initiative to improve pediatric pain management during needle procedures. While only two data points exist for our primary SMART aim at submission, additional data will be available by the presentation date. Our findings indicate that integrating CP in outpatient primary care is feasible, well-received, and has the potential to significantly enhance the patient experience during painful procedures.