Office of Technology Transfer – University of Michigan

Procedure Plan and Comfort Measures for needle phobia

Technology #7034

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Poke Program
Sandra I. Merkel
Managed By
Drew Bennett
Associate Director - Software Licensing 734-615-4004

Intravenous insertions, venipuncture and immunizations are common sources of pain in hospitalized children and in children receiving care in clinics. Pain from these procedures result in short-term suffering and also influence future responses to pain and treatments. A child’s comfort is important to parents as they often are present to watch the procedure and find it difficult to console their child. All patients, no matter what age need comfort during healthcare experiences to reduce anxiety and pain. Literature indicates that both drug and non-drug therapies are beneficial to all individuals during procedures. There is currently no universal protocol or standardized bed-side manner to deal with patients that have heightened anxiety around needles.

Standardized Plan to deal with needle phobia

A multidisciplinary team with patient and family advisors developed a poke and procedure plan that can be used to incorporate strategies and interventions and comfort techniques to help patients of all ages communicate their voice of experience and choice for procedure comfort.


Sandra I Merkel, MS, RN-BC Julie Piazza, MS, Certified Child Life Specialist Catherine Desmet BSN, RN


  • Useful for pediatrics, special needs, high anxiety, needle phobia, patients with repeated needle sticks and painful procedures

  • Relevant for patients with traumatic experiences, heighten anxiety, fear, and/or unable to express their needs

  • Inclusion into patient education materials

  • Incorporated into the electronic medical record

  • Advantages

  • Facilitate communication across disciplines

  • Quick and easy to use

  • Promotes consistency of care

  • Identifies individual fear, anxiety and coping skills

  • Honors patients/families preferences and choices

  • Central place for communication of comfort

  • Translated into 5 languages: Arabic, Chinese, Japanese, Korean, Spanish

  • Opportunity to teach coping skills for future procedures

  • Increases healthcare professional’s comfort in administering injections

  • Presentations for the Poke & Procedure Plan:

    Making Needlesticks Less Painful: A Strategic Plan” Child Life Council Annual Conference, Chicago, Illinois, May 28, 2011

    “Making Needlesticks and Procedures Less Painful for Children” American Society of Pain Management Nursing, Tucson, Arizona, September 2011

    “Needlesticks and Procedures: Does a child have a voice?” Sparrow Hospital, Lansing, MI, October 2011

    “The Poke Plan: An effect strategy to decrease needlestick pain” 2012 Society for Pediatric Sedation Conference, Cleveland, OH, May 20-22, 2012

    “Strategies to Decrease Needle Stick Pain Associated with Immunizations” Michigan Department of Community Health, Division of Immunization, Lansing MI, August 2, 2012

    “Building Bridges to Give a Voice and a Choice to Children Undergoing Procedures” University of Michigan Staff Works Conference, Ann Arbor, MI, December 5, 2013

    Posters “Needlesticks and Procedures: Decreasing Pain and Anxiety in Pediatric Patients” Society of Pediatric Nursing, 20th Annual Convention; Orlando, Florida, June 2011 Regional Pain Conference in Ypsilanti, MI, September, 2010 UMHS Evidence Based Conference in March 2011. 5th International Conference on Patient-Family Centered Care; June 4-6, 2012 Washington DC

    “Procedural Pain Reduction and Comfort for Patients Undergoing Ophthalmic Surgery” UMHS Quality Month, October 6-7, 2015