A Pilot Program to Reduce Distress During Blood Draws in Children with Autism Spectrum Disorders

Background: Blood draws for children with autism are very difficult. They can be so anxiety producing for the families of children with autism that they simply don't have them done for fear of what might happen. Many families have had prior experiences in the lab that they describe as negative, such as procedures requiring restraint or lasting for an extraordinary amount of time. The goal of this quality improvement project was to remove the barriers to children moving in and out of the lab quickly, and avoiding further negative associations with the lab.

Objectives:

• Eliminate wait times wherever possible
• Prepare the families
• Have staff present who are familiar with autism
• Have a coping plan for each kid coming to the clinic that day

Methods: After children were identified as needing a blood draw, each family was contacted by a Child Life Specialist to discuss prior lab experiences. A coping plan for that child was prepared and written down. The plans focused on distractors that would be helpful in the phlebotomy room. Families were scheduled to come to the lab, on a Saturday, at 30-minute intervals, to avoid waiting. Staff present on the day of the clinic included Autism Center staff (including at least one nurse), a Child Life Specialist, and a dedicated phlebotomist for the QI project lab. Families were met and escorted directly to the phlebotomy room. Phlebotomist confirmed identification with the family, and blood draw was performed. Cycle times were recorded and each family was contacted for a follow-up phone interview.

Results: Over the course of three different dates, 19 kids were scheduled in the pilot sessions. Time for the draws, from meeting at the door to leaving the phlebotomy room ranged from approximately 2 minutes to just over 6 minutes, excluding the family that took 29 minutes whose blood draw was unsuccessful. Parental feedback noted significant satisfaction with cycle time, presence of staff familiar with autism, prior preparation including coping plans and materials on hand such as preferred video. Choosing a Saturday during less busy laboratory hours allowed both parents to attend or one parent could be home with siblings.

Conclusions: The three pilot sessions were a considerable success. These strategies demonstrate to parents and hospital staff that children affected by autism can successfully undergo painful procedures with minimal trauma and restraint. Preparation of staff and families are key components, which can be replicated in other settings such as immunization clinics, radiology procedures, emergency room visits and surgical/medical hospitalizations.

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