1. Knowledge Translation for immunisation pain management: Barriers and solutions.
Dr Kathryn Russell
Senior Clinical Psychologist
Paediatric Consult Liaison Team Kidz First/Whirinaki
Date:
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2. Change is easy
On October 16th 1846 in Massachusetts Ether was used by Henry Bigelow and William Morton.
Published: November.
Used in Paris and London: December.
Within 7 years almost every hospital in America and Britain had adopted the new discovery.

3. Change is hard In 1867 Sepsis killed half of all surgical patients.
In 1867 Joseph Lister used carbolic acid for cleaning hands, instruments, wounds, and operating tables.
Published in the Lancet 1867.
20 years later – surgical hand washing still optional, instruments soaked in carbolic acid, but operating environments were not cleaned between patients, dirty bandages were reused, surgeon's wore their blood and guts covered aprons with pride!
Finally in the 1890’s sterile lab environments created in operating rooms.
(In the 1820’s doctor hand washing between patients was found to save patient lives, in the 1850’s Florence Nightingale insisted hygiene and cleanliness were important, and in the early 1860’s Louis Pasteur pondered germs and their relationship to disease)

4. Why?
Why such a difference when both were well published and evidence based!!
Why was anaesthetics adopted within a year, and very widely adopted within 7 years. It involved more staff, and expensive drugs. It reduced pain but didn’t have a big impact of life or death?
Why did sterile practices take more than 20 years to catch on when they saved so many lives and required no additional staff, and minimal cost?
Both were well published – both evidence based!!
One made the surgeons job easier (didn’t have to hold down screaming patients – results instantly seen) – the other required much more work – to kill invisible creatures that many doctors didn’t believe in. It was a huge shift in practice.

5. Awareness versus use (review by Brett 1987)
Policy
Nurses aware of policy
Nurses who applied policy in practice
Closed sterile drainage
95%
79%
Intravenous site change
94%
27%
Formal pre-op programme
87%
33%
Mutual goal setting
83%
15%
Urine testing
65%
21%
Relaxation techniques
77%
20%
Oral temperature taking
63%
28%
Tube feedings
47%

6. What about general medical care?
McGlynn, et al Reviewed the treatment of 6712 patients over 12 cities with a range of conditions over a 2 year period.
Overall 55% had received recommended care (based on best practice).
Recommended preventive care (54.9 %),
Recommended acute care (53.5 %),
Recommended care provided for chronic conditions (56.1 %).
Quality varied according to the particular medical condition: recommended care cataract (78.7 %) versus recommended care for alcohol dependence (10.5 %) .

7. We could just keep doing what we are doing.

8. What is knowledge translation
Evidence seeking research
Evidence
Practice
Knowledge based practice

10. Barriers – the research-practice gap
Share volume of research evidence (up to two thousand new medical research articles every day!!)
Access to good quality evidence
Time to read, learn and understand
Financial constraints, equipments costs
Skill mix
Knowledge, attitudes and beliefs
Motivation to change
Communication
500,000 peer reviewed medical articles a year. RCT’s: 26,017 in (do you read 100+ RCT articles a week?) over 1,000,000 articles in pubmed. Grows by 7% a year.

11. Professional behaviour change
Good systematic reviews – reliable research.
Simple, focused and clear information
Printed educational material/ web based learning
Educational meetings (workshops/lectures)
Educational outreach – trainer going person to person (achieves the social connection required for change – word of mouth)
Local opinion leaders
Audit and feedback
Policy makers
Reminders
Incentives (CME credits)
Focus on educating consumers – pressure applied from them

12. How does this apply to pain management in immunisations in NZ?
What are we doing?
IMAC have learning website with newly up-to- date recommendations
We are working on a NZ resource for parents/children based on the Canadian HELPinKIDS model

14. Training videos
For immunisers
For Parents

15. What do we need? Volunteers to try it out People to spread the word
Funding for developing and distributing the resource
Funding for training
Other things?