This study suggested that Japanese neonatal intensive care units need national guidelines for pain management, and these might improve collaboration between nurses and physicians in minimizing neonatal pain.

No abstract

Background:Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan.Purpose:To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs).Methods:Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months).Findings:Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions.Implications for Practice:The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs.Implications for Research:Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting.

Our study suggests that mothers require support during babies' hospitalization in the NICU and for the process of decision-making about a subsequent pregnancy. Family-centered care as the basis for nursing practice in the NICU is ideal to provide this type of support.