Children can be traumatized when having to undergo a painful procedure. Whether it is insertion of an intravenous cannula or a routine intramuscular injection for immunization, for many children, exposure to these painful procedures can lead to major issues on subsequent exposures (Walco & Goldschneider, 2007, p.65). Therefore to reduce this distress and subsequent problems, topical anaesthetics have been used routinely for children in the emergency department as evidence shows that with the use of topical anaesthetics have the effect of reducing pain and distress during these painful procedures.
Two of the common topical anaesthetic agents used in emergency departments are amethocaine gel (or An Gel cream) and EMLA cream. Amethocaine gel is used exclusively in the general emergency department I work in for intravenous cannulation or venepuncture in children. Amethocaine gel is considered to be the more favourable choice in topical anaesthetics and replaced EMLA cream. In fact, the staff was given little choice but to use the Amethocaine gel as EMLA was completely removed from the department. As little education was given on Amethocaine gel when it was introduced, or why it is assumed amethocaine gel was better than EMLA, is was what precipitated further investigation into the introduction and use of this topical anaesthetic.
Evidence suggests that the benefit of Amethocaine gel has over EMLA is in that the time of application to needle time is significantly reduced (Lander, Weltman, & So, 2009, p.14). Newbery and Herd (2008, p.491) state that amethocaine’s mode of action could save time and therefore associated costs to the emergency department. This is significant as it decreases the delay in commencing treatment, which assists in decreasing patient stay in the emergency department, and also decreases stress to the child and care giver awaiting procedure.
Because of the lack of education with the introduction of Amethocaine gel into the department I work in, inconsistent use of this topical anaesthetic has been observed and there is inefficient or not enough effective utilization been made of this topical anaesthetic. For example, application is underutilized as it can be applied at triage but this practice does not occur, and or nil application, as staff were unaware of the use of this in children from 1 month or could be used for intramuscular injections. Without the education on differences of Amethocaine compared to EMLA, staff familiar with EMLA cream tended to follow the same practices of this topical anaesthetic, given that usage was for the exact same procedures, both drugs are anaesthetics, and both applied in exactly the same way. There was an assumption that if there was no information forthcoming, they must then needed to be treated exactly the same way, as this was the only information available to them. Implementing a clinical practice guideline would be of significant benefit as it can be used by the practitioners to guide the use of amethocaine gel effectively, consistently, and thus improve on patient outcomes.
Evidence Based-Practice (EBP) Model
Several models exist for EBP implementation. By using a model to guide and assist with change, it in turns encourages commitment to the implementation of the required change (Glenn, 2010, p.12). Several models were developed as guides for integrating research into practice which moves away from the traditional and intuition sources for accessing knowledge (Rosswurm & Larrabee, 1999, p.318). Some of the models include the Stetler, Kitson’s PARIHS (1998), and Rosswurm and Larrabee (1999) models. The PARIHS framework was a model developed as a result of the complexity of change and looks at three specific aspects of evidence, context, and facilitation which the relationship of each are interrelated and dynamic (Malone, 2004, p.298). When these aspects are positioned high on a continuum it is considered that the implementation of change...
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